Choriocarcinoma

Testis and epididymis
Germ cell tumors
Choriocarcinoma

Author: Andres Matoso, M.D.

Topic Completed: 1 December 2017

Revised: 28 March 2019

Copyright: 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: Choriocarcinoma[TI] testis

Page views in 2019: 7,207

Page views in 2020 to date: 1,030

Table of Contents

Cite this page: Matoso A. Choriocarcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/testischorio.html. Accessed February 21st, 2020.

Definition / general

Malignant germ cell tumor composed of syncytiotrophoblast, cytotrophoblast and intermediate trophoblast cells
Identical tumors arise in placenta, ovary, mediastinum and abdomen (from sequestered cell rests)

Essential features

Hemorrhagic mass
Early metastases
Three cell types: syncytiotrophoblast, cytotrophoblast, intermediate trophoblast

Epidemiology

Young men, 25 - 35 years old

Sites

Testis, retroperitoneum, mediastinum

Pathophysiology

Unknown

Etiology

Unknown

Clinical features

0.3 - 1% of germ cell tumors are pure choriocarcinoma but mixed tumors are more common (8%)
May present initially with metastases (liver, lung, mediastinum, retroperitoneum) with normal testis or small tumor but with increased serum hCG
Early hematogenous spread to lungs, liver and brain
Poor prognosis if pure
May present with gynecomastia or hyperthyroidism

Diagnosis

Histopathology

Laboratory

High hCG levels (greater than 100,000 mIU/ml)

Prognostic factors

Poor prognosis if pure and presents in advanced stage

Case reports

20 year old man with pure testicular choriocarcinoma with pulmonary metastases (Case Rep Oncol Med 2015;2015:345018)

Treatment

Surgery and chemotherapy

Gross description

Hemorrhagic tumor or scar

Gross images

Images hosted on PathOut server:

Images contributed by Dr. Andres Matoso:

Large hemorrhagic tumor

Microscopic (histologic) description

Tumor is composed of varying amounts of:
- Syncytiotrophoblast cells: large multinucleated cells with large irregular nuclei
- Cytotrophoblast cells: pale cytoplasm with single large nucleus and prominent nucleolus
- Intermediate trophoblast cells: clear cytoplasm, larger than cytotrophoblasts with single nuclei
- Adjacent testicular parenchyma with intratubular germ cell neoplasia in situ

Microscopic (histologic) images

Images hosted on PathOut server:

Images contributed by Dr. Andres Matoso:

Cytotrophoblasts and syncytio-trophoblasts

In a vessel of the albuginea

Images hosted on other servers:

Cytotrophoblasts and syncytio-trophoblasts

Cytotrophoblastic cells

Syncytio-trophoblastic cells

Abundant syncytio-trophoblasts

Syncytio-trophoblasts

hCG+

Positive stains

hCG, PLAP, GATA3, EMA, cytokeratin 7, SALL4, glypican 3

Negative stains

CD30, D2-40, OCT3 / 4, inhibin, SF1

Molecular / cytogenetics description

Isochrome 12p

Differential diagnosis

Embryonal carcinoma
Nonchoricarcinoma trophoblastic tumors
Seminoma with syncytiotrophoblastic cells: these are usually found in clusters around blood vessels; may cause elevation of hCG in the hundreds of IU/ml
Trophoblastic differentiation in carcinomas: i.e. urothelial carcinoma (very rare)

Additional references

Am J Surg Pathol 2014;38:e50, Am J Surg Pathol 2017;41:788, Histopathology 2017;70:513

Board review style question #1

Which biomarker is most frequently elevated in choriocarcinoma?

hCG in the hundreds level
hCG in the thousands level
hGH
T4

Board review answer #1

B. hCG in the thousands level

Board review style question #2

Which of the following germ cell tumor markers is positive in choriocarcinoma?

CD30
CD117
OCT3 / 4
SALL4

Board review answer #2

D. SALL4

Board review style question #3

Which of the following markers helps to differentiate choriocarcinoma from embryonal carcinoma?

CD117
Cytokeratin
EMA
OCT4

Board review answer #3

D. OCT4