Elsevier

Gynecologic Oncology

Volume 102, Issue 1, July 2006, Pages 111-117
Gynecologic Oncology

Case Reports
Ovarian nongestational choriocarcinoma mixed with various epithelial malignancies in association with endometriosis

https://doi.org/10.1016/j.ygyno.2006.01.001Get rights and content

Abstract

Background

Ovarian choriocarcinoma (CC) is rarely encountered as compared to uterine CC. Furthermore, ovarian CC coexisting with surface epithelial tumor is very rare.

Case

A 50-year-old postmenopausal woman, gravida 0, was admitted to our hospital with abdominal pain and distention due to a complex ovarian tumor. The laboratory data showed high serum level of CA125, neuron specific enolase (NSE), and hCG β-subunit C-terminal peptide (hCG-β-CTP). Total abdominal hysterectomy, right salpingoophorectomy, and lymph node dissection were performed. The right ovary revealed a cystic tumor with two solid parts: larger part, endometrioid adenocarcinoma and small cell carcinoma; smaller part, predominantly CC and focally clear cell adenocarcinoma. CA125 was rapidly decreased after first operation, but hCG-β-CTP levels repeated distinctive fluctuations and NSE abruptly increased during the last few months before death. The patient died 10 months after the first operation.

Conclusion

Only four cases of ovarian nongestational CC coexisting with surface epithelial tumor have been reported. This is the first reported case of admixture of CC with three epithelial malignancies. We assume that endometrioid and clear cell adenocarcinomas arose at different sites as tumorigenic factors in association with endometriosis, and the former may have been dedifferentiated into small cell carcinoma and the latter to CC. Coexistence of CC with small cell carcinoma is considered to be responsible for relative chemoresistance leading to poor prognosis.

Introduction

Most cases of choriocarcinoma (CC) occur in the uterine body in association with an antecedent pregnancy. The diagnosis of CC can be predicted by the measurement of serum or urinary human chorionic gonadotropin (hCG) prior to an operation. Ovarian nongestational CC is occasionally encountered as a part of mixed germ cell tumors [1]. However, only 30 cases of the pure form of nongestational ovarian CC have been reported. Coexistence of ovarian CC with surface epithelial tumors instead of germ cell tumors is very rare. There have been only four reported cases of ovarian CC coexisting with epithelial tumors, such as poorly differentiated carcinoma [2], mucinous cystadenocarcinoma [3], and mucinous cystadenoma [2], [4]. Herein, we report a case of nongestational ovarian CC in conjunction with mixed epithelial carcinomas; the first reported case of an admixture of endometrioid, clear cell, and small cell carcinoma with choriocarcinoma in a background of endometriosis. In this study, the clinical and pathological features of this condition have been discussed.

Section snippets

Case report

A 50-year-old postmenopausal woman, gravida 0, was admitted to our hospital with abdominal pain and distention. The past medical history of the patient revealed that the patient had undergone a left salpingoophorectomy because of ovarian endometriosis at the age of 25 years. At the age of 47 years, she was admitted to our hospital with abdominal pain. Magnetic resonance imaging (MRI) revealed a 10 × 10 × 6.5 cm-sized cystic mass without a solid part in the pelvic cavity. Since the mass was

Discussion

Ovarian nongestational CC is occasionally shown to be mixed with other germ cell tumors [1]. Choriocarcinomatous differentiation rarely occurs in carcinomas of various origins, such as the stomach, colon, liver, gallbladder, breast, urinary bladder, prostate, uterus, and ovary [2]. The prognosis of these tumors is unfavorable because of rapid tumor growth with metastatic disease and resistance to usual chemotherapeutic regimens [3]. The most plausible explanation for the association of

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