Testis & epididymis

Germ cell tumors


Topic Completed: 1 December 2017

Minor changes: 15 November 2021

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PubMed Search: Choriocarcinoma[TI] testis

Andres Matoso, M.D.
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Cite this page: Matoso A. Choriocarcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/testischorio.html. Accessed December 4th, 2021.
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
  • Young men, 25 - 35 years old
  • Testis, retroperitoneum, mediastinum
  • Unknown
  • 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
  • Histopathology
  • High hCG levels (greater than 100,000 mIU/ml)
Prognostic factors
  • Poor prognosis if pure and presents in advanced stage
Case reports
  • Surgery and chemotherapy
Gross description
  • Hemorrhagic tumor or scar
Gross images

Contributed by Andres Matoso, M.D.

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

Contributed by Andres Matoso, M.D.

Cytotrophoblasts and syncytio-trophoblasts

In a vessel of the albuginea

Images hosted on other servers:


Positive stains
Negative stains
Molecular / cytogenetics description
  • Isochrome 12p
Differential diagnosis
Board review style question #1
Which biomarker is most frequently elevated in choriocarcinoma?

  1. hCG in the hundreds level
  2. hCG in the thousands level
  3. hGH
  4. T4
Board review style answer #1
B. hCG in the thousands level

Comment Here

Reference: Choriocarcinoma
Board review style question #2
Which of the following germ cell tumor markers is positive in choriocarcinoma?

  1. CD30
  2. CD117
  3. OCT3 / 4
  4. SALL4
Board review style answer #2

Comment Here

Reference: Choriocarcinoma
Board review style question #3
Which of the following markers helps to differentiate choriocarcinoma from embryonal carcinoma?

  1. CD117
  2. Cytokeratin
  3. EMA
  4. OCT4
Board review style answer #3

Comment Here

Reference: Choriocarcinoma
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