Choriocarcinoma, referred to as villous carcinoma, is a very malignant tumor. Most choriocarcinoma is associated with pregnancy, secondary to hydatidiform mole, miscarriage, or normal delivery. It has also been reported that it can occur directly from pregnant eggs and even very rarely from the trophoblastic components of eggs contained in teratomas. The occurrence of tubal pregnancy or abdominal pregnancy is rare.
A. different history of pregnancy choriocarcinoma is from an abnormal or normal pregnancy, but at least 50% has an obvious history of hydatidiform mole. According to 414 cases of choriocarcinoma in Beijing with definite previous pregnancy history, 56.8% of them directly came from the previous pregnancy with hydatidiform mole. The previous pregnancy was miscarriage or full-term delivery, but had a history of hydatidiform mole, which was considered to be derived from hydatidiform mole, the choriocarcinoma was derived from hydatidiform mole, the rate was 69.1%, the villi latent in the body of hydatidiform mole has no doubt. The malignant rate of hydatidiform mole trophoblast cells was much higher than that of pregnant cells. According to the report, 16 percent of those who had a history of hydatidiform mole during abortion later developed choriocarcinoma. The rate of hydatidiform mole in term pregnancy was 35%. This suggests the potential danger of having a history of hydatidiform mole.
2. Irregular vaginal bleeding after the birth or after a miscarriage, especially after a hydatidiform abortion. Bleeding may follow immediately after birth or abortion, or may occur at intervals. Very few even bleed during pregnancy. The amount of blood can be large or small. After postpartum or abortive uterus cannot be restored as scheduled, some still increase even. Some vaginal bleeding comes from vaginal nodules.
Vaginal bleeding is the earliest and most common symptom of choriocarcinoma. But individual also does not have haemorrhage symptom person.
(1) abdominal mass long course of disease and uterine enlargement is more obvious, or the formation of large hematoma metastases in the broad ligament, can appear abdominal mass. Individual primary hair is in ovarian or oviduct person, also can appear below abdomen bag piece.
(2) abdominal pain is caused by cancer erosion of the uterine wall or uterine cavity accumulation of blood clots. Acute abdominal pain may be caused by bleeding from velvet carcinoma that penetrates into the abdominal cavity or metastases to the liver.
1. Lung metastasis is common, and patients may have blood clot symptoms, or be detected by chest X-ray or lung photography due to other diseases.
2, vaginal, vulva metastasis nodules in gynecological examination is easy to see, for round or oblong, 1 to a few centimeters in diameter, the lower front wall of the vagina more, sometimes rupture bleeding, a small number of vaginal flow.
3. Brain metastasis also occurs from time to time. Subarachnoid hemorrhage can be caused by brain parenchymal metastasis or penetration of arachnoid membrane. Patients present with headache and space-occupying lesions, such as paralysis of a limb. Bleeding for a long time, will appear coma, or even immediate death. In some patients, coma and death occurred suddenly, which was confirmed by autopsy as cerebral choriocarcinoma, but no primary lesion was found in the uterus.
4. Retinal metastasis; some bilateral retinas were invaded. It did not mention whether his vision was fully restored.
1. Liver metastasis: pain and hepatomegaly in the liver region, which can be misdiagnosed as cholecystitis or amoeba hepatic abscess. Jaundice: the result of extensive liver metastasis. 3. Abdominal bleeding: acute abdominal pain occurs. Internal bleeding may result from rupture of the liver, spleen, uterus, or fallopian tube. Sudden massive internal bleeding often leads to shock and even death. 4. Intestinal bleeding: upper gastrointestinal bleeding presented as black stools and ink stools, while fresh bleeding occurred when the metastatic focus was close to the anus. Often accompanied by abdominal pain.
6, amenorrhea individual choriocarcinoma cases not only occur uterine bleeding, but also have amenorrhea symptoms.
Naked eye view, cancer nodule is shown singly or many, be located in the different position of uterus, big person can protrude uterine cavity, often invade deep muscle layer, penetrate uterine wall to reach outside serous membrane even. Due to obvious hemorrhage and necrosis, the nodules are soft and dark red or purple-blue in color.
Microscopically, the tumor is composed of poorly differentiated cytotrophoblast and somatic trophoblast cells. The two types of cells are mixed and arranged in nests or cords. Occasionally, individual nests are composed mainly of one type of cell. The tumor itself has no interstitial blood vessels and relies on invading host blood vessels for nutrition. Therefore, there is obvious bleeding and necrosis in the cancer tissue and surrounding normal tissues, and sometimes most of the cancer cells are necrotic, with only a few remaining cancer cells found in the edge. Cancer cells do not form villous or vesicular structures, which is distinct from aggressive hydatidiform moles.
In addition to the uterus, choriocarcinoma may occur at the corresponding site of ectopic pregnancy as well as in the hydatidiform mole.
The spread of
Choriocarcinoma has a strong ability to invade and destroy blood vessels. In addition to local destruction and spread, choriocarcinoma is easily transferred through blood channels. Lung and vaginal walls are the most common, followed by brain, liver, spleen, kidney and intestine. In a few cases, metastases may resolve spontaneously after excision of the primary lesion.
Clinical and pathological links
The main clinical manifestations are hydatidiform foetus abortion and several months or even years after pregnancy. The vagina presents continuous irregular bleeding, uterine enlargement, and continuous increase of blood or urine HCG. Hematogenous metastasis is a prominent characteristic of choriocarcinoma. The presence of metastases in different sites can cause corresponding symptoms. If there are lung metastasis, hemoptysis, chest pain; Brain metastasis can cause headache, vomiting, paralysis and coma. Renal metastasis may present hematuria and other symptoms.
Choriocarcinoma is a malignant tumor with a high degree of malignancy. Since the application of chemotherapy, the cure rate has improved significantly, and the mortality rate has been reduced to less than 20%.