Germ cell tumors

Topic Completed: 1 October 2013

Minor changes: 6 March 2020

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PubMed Search: Choriocarcinoma ovary

Leena Varughese, M.D.
Page views in 2019: 4,121
Page views in 2020 to date: 2,120
Cite this page: Varughese L, Malliah R. Choriocarcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ovarytumorchorio.html. Accessed August 11th, 2020.
Definition / general
  • Rare primary ovarian tumor; < 1% of primitive ovarian germ cell tumors
  • May develop from ovarian pregnancy (gestational choriocarcinoma), as a germ cell tumor (pure or mixed, non-gestational choriocarcinoma) or as a surface epithelial tumor with choriocarcinomatous differentiation
  • Primary ovarian choriocarcinomas are more common in children and adolescents
  • After puberty, origin from an ovarian ectopic pregnancy cannot be excluded
Clinical features
  • Presentation similar to ectopic or tubal pregnancy
  • Abdominal enlargement
  • Pain, sometimes hemoperitoneum
  • Isosexual precocity, menstrual abnormalities, androgenic changes
  • Markedly elevated serum β hCG
  • Monitoring serum levels of β hCG is helpful in predicting recurrence and response to therapy
Radiology description
  • On imaging, appears as vascular solid tumor with cystic, hemorrhagic, necrotic areas
Prognostic factors
  • In contrast to gestational choriocarcinomas, non-gestational choriocarcinomas are difficult to treat, generally unresponsive to chemotherapy
  • Metastases to lungs, liver, bone and viscera are common at diagnosis
Case reports
  • Surgery, chemotherapy
Gross description
  • Hemorrhagic, soft, tan with necrosis
Gross images

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Hemorrhagic mass

Ovarian mass

TAHBSO specimen

Microscopic (histologic) description
  • Composed of cytotrophoblast, intermediate trophopblast and multinucleated syncytiotrophoblast around periphery of blood channels
  • Cytotrophoblasts have clearly defined cytoplasmic borders, are mononucleated with vesicular nuclei and distinct nucleolus
  • Syncytiotrophoblasts contain basophilic to amphophilic cytoplasm with mutiple nuclei
Microscopic (histologic) images

AFIP images

Plexiform pattern

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H&E stain

Atypical syncytio

β hcG+

Positive stains
  • Cytokeratin, CD10, human placental lactogen, EMA
  • Syncytiotrophoblasts are hCG+
Negative stains
Molecular / cytogenetics description
Differential diagnosis
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