Term pregnancy with choriocarcinoma presenting as severe fetal anemia and postpartum hemorrhage

Intraplacental Gestational Neoplasms: A Review of Clinically Relevant Diagnostically Challenging Lesions

CONTEXT.—

Case studies reporting intraplacental choriocarcinoma (IPC) and intraplacental "chorangiocarcinoma" have recently increased, with IPC also represented in molecular analyses of gestational trophoblastic neoplasms.

OBJECTIVE.—

To provide an overview of 2 intraplacental neoplastic lesions that can have a significant impact on both mother and fetus/infant, focusing on diagnostic characteristics, and ancillary and molecular tools that support diagnosis, determine prognosis, and further elucidate the nature of these lesions.

DATA SOURCES.—

Data were compiled from a PubMed literature review that included diagnostic and additional keywords within the scope of study for gestational choriocarcinoma in general. Illustrative cases were retrieved from the pathology archives at Michigan Medicine, including the consultation files of the author.

CONCLUSIONS.—

Intraplacental gestational tumors exist along the spectrum of benign (chorangioma) to aggressive malignant (choriocarcinoma) neoplasms with a high potential for metastasis. Although most gestational choriocarcinomas follow complete hydatidiform mole, 20% to 25% occur in association with normal intrauterine gestations, including rare cases in which they are detected within the placenta (IPC). IPCs range from asymptomatic to widely metastatic, with metastases possible even when only microscopic IPCs are present. A second, even less common lesion, variably called "chorangiocarcinoma" and chorangioma with atypical trophoblast proliferation, is also reviewed. The incidence of these lesions is likely to be underestimated. Heightened suspicion and more liberal placental sampling, particularly when specific clinical features are present, may result in higher detection. Enhanced detection to provide the earliest intervention for both mother and infant may improve prognosis, particularly for asymptomatic disease that may later present with metastasis.

Maternal and fetal outcomes of intraplacental choriocarcinoma complicated by fetomaternal hemorrhage: a systematic review

INTRODUCTION

Intraplacental choriocarcinoma is a gestational trophoblastic neoplasia located within the placenta. Due to the usual silent presentation, more than half of the cases are diagnosed incidentally. It has been demonstrated that this pathology is linked to feto-maternal hemorrhage (FMH), stillbirth, and intrauterine growth restriction. The aim of our review was to establish if there are recurrent signs that might lead to an early diagnosis and better management in cases complicated by FMH.

MATERIALS AND METHODS

We performed a systematic review of the literature from 2000 up to March 2023. The adopted research strategy included the following terms: (gestational choriocarcinoma obstetrics outcome) AND (intraplacental choriocarcinoma) AND (gestational choriocarcinoma). The MEDLINE (PubMed), Google Scholar, and Scopus databases were searched.

RESULTS

The research strategy identified 19 cases of FMH coexisting with intraplacental choriocarcinoma (IC), as described in 17 studies. The perinatal mortality rate was 36.8%. In eight cases, histological diagnosis of IC was made post-delivery. Metastatic lesions were found in 75% (6/8) of described cases. One case of maternal death has been described. Chemotherapy was necessary in seven cases. Sporadical prenatal ultrasound signs were described.

DISCUSSION

The diagnosis of IC is usually delayed, mostly due to aspecific symptoms and signs. Histological analysis of the placenta, when not routinely performed, should be performed when warning symptoms are encountered. The maternal prognosis was good, with a mortality rate of 5.5%. A fertility-sparing approach is always possible even in the presence of metastasis. Chemotherapy seems to be useful in cases of maternal and neonatal metastasis.

Hemoptysis as primary manifestation in three women with choriocarcinoma with pulmonary metastasis: a case series

Background

Gestational choriocarcinoma is the most common gestational trophoblastic neoplasia; it is often secondary to hydatidiform mole, as well as to abortion, ectopic pregnancy, premature delivery, or term delivery. Approximately 60% of patients with choriocarcinoma develop pulmonary metastases, but for patients with a respiratory condition, choriocarcinoma with lung metastasis is a relatively rare lung cancer diagnosis. Three cases of choriocarcinoma with pulmonary metastasis who had the primary symptom of hemoptysis are described.

Case presentation

This case report describes a 35-year-old Chinese woman of Han nationality, a 23-year-old Chinese woman of Han nationality, and a 46-year-old Chinese woman of Han nationality whose primary symptom was hemoptysis and different chest imaging manifestations; they were finally diagnosed as having pulmonary metastatic choriocarcinoma. All patients had low risk factors, including abortion, hydatidiform mole, and ectopic pregnancy. Human chorionic gonadotropin played an important role in choriocarcinoma diagnosis.

Conclusions

Based on the diagnosis and treatment of the three patients, we suggested that for women with pregnancy history and hemoptysis (particularly in the presence of risk factors such as abortion, hydatidiform mole, ectopic pregnancy, and >35-years old), choriocarcinoma may be the possible diagnosis or at least the main differential diagnosis.