Choriocarcinoma is a highly malignant tumor that arises from chorionic epithelium. About 50% of cases develop after molar pregnancies or hydatidiform moles, while 30% occur after miscarriages and 20% after normal pregnancies. The primary site is usually anywhere in the uterus, though rarely it starts in the fallopian tubes or ovaries. It spreads rapidly through vascular erosion, commonly metastasizing to the lungs in 80% of cases, anterior vaginal wall in 30%, and brain and liver in 10% each. Symptoms include persistent ill health, irregular vaginal bleeding, and continued amenorrhea, as well as coughing, breathlessness, or headaches from metastatic sites.

1. CHORIOCARCINOMA

2. • Choriocarcinoma is a highly malignant tumor arising from the
chorionic epithelium.
• About 50 percent of all patients with molar pregnancies/
hydatidiform mole develop choriocarcinoma.
• 30 percent occur after a miscarriage or an ectopic pregnancy
• 20 percent after an apparently normal pregnancy.

3. PATHOLOGY
The primary site is -
• Anywhere in the uterus.
• Rarely, it starts in the tube or ovary.

4. NAKED EYE APPEARANCE
• DIFFUSE AND LOCALIZED
• The lesion is usually localized nodular type. The nodular
type may be located deep in the myometrium with
overlying endometrium intact.
• It looks red, hemorrhagic and necrotic.
• At times, the lesion is diffuse involving the entire
endometrium.

5. MICROSCOPIC APPEARANCE
• There are anaplastic sheets or columns of trophoblastic cells
invading the uterine musculature.
• Evidences of necrosis and hemorrhage.
• Villus pattern is completely absent.

6. SPREAD
• Local spread common
• Vascular erosion takes place early and hence distant metastases
occur rapidly.
• The common sites of metastases are
• lungs (80%),
• anterior vaginal wall (30%),
• brain (10%),
• liver (10%)

7. CLINICAL FEATURES
Symptoms :
• Persistent ill health.
• Irregular vaginal bleeding, at times brisk.
• Continued amenorrhea.
Other symptoms due to metastatic lesions are:
• Lung: Cough, breathlessness, hemoptysis.
• Vaginal: Irregular and at times brisk hemorrhage.
• Cerebral: Headache, convulsion, paralysis or coma.
• Liver: Epigastric pain, jaundice.

8. Signs:
• Patient looks ill.
• Pallor of varying degrees.
• Bimanual examination reveals subinvolution of the uterus.
• There may be a purplish red nodule in the lower-third of the anterior
vaginal wall

9. FIGO STAGING