Choriocarcinoma and trophoblastic tumours
- Lesion
Cancers of placental cells: choriocarcinoma spreads fast through the blood but is usually curable with chemotherapy; its rarer cousins resist chemotherapy.
What it is
Gestational trophoblastic neoplasia includes invasive mole, choriocarcinoma and the rarer tumours of intermediate trophoblast. Gestational choriocarcinoma is a highly malignant tumour of cytotrophoblast and syncytiotrophoblast without villi, arising after a complete mole, a miscarriage, a normal pregnancy or an ectopic pregnancy. It invades vessels early and metastasises to the lungs, vagina, brain and liver, yet it is among the most chemosensitive solid tumours. Placental site trophoblastic tumour and epithelioid trophoblastic tumour make little hCG, grow slowly and are treated mainly with surgery.
Structure
- Choriocarcinoma: a soft, necrotic, haemorrhagic mass in the uterus; biphasic trophoblast with marked atypia.
- Placental site trophoblastic tumour: a mass of mononuclear intermediate trophoblast that separates muscle fibres and replaces vessel walls with fibrinoid, mimicking the normal implantation site.
- Epithelioid trophoblastic tumour: nests of uniform cells with eosinophilic hyaline material and necrosis, often in the lower segment or cervix.
- Exaggerated placental site and placental site nodule: benign, non-mass lesions of implantation-site trophoblast.
Step by step
- Trophoblast from a pregnancy, molar or not, escapes normal control.
- Malignant cytotrophoblast and syncytiotrophoblast invade the myometrium and its vessels, as normal trophoblast does but without limit.
- Vascular invasion sends tumour emboli to the lungs and beyond, where they bleed.
- Syncytiotrophoblast secretes hCG, which is used to diagnose, stage and follow the disease.
Gestational trophoblastic neoplasms compared
| Tumour | Cell type | hCG | Response to chemotherapy |
|---|---|---|---|
| Invasive mole | Molar villi with trophoblast in the myometrium | High | Good |
| Choriocarcinoma | Cytotrophoblast and syncytiotrophoblast, no villi | Very high | Excellent |
| Placental site trophoblastic tumour | Implantation-site intermediate trophoblast (hPL) | Low | Poor; surgery |
| Epithelioid trophoblastic tumour | Chorionic-type intermediate trophoblast (p63) | Low | Poor; surgery |
Markers
- hCG (serum and syncytiotrophoblast)
- hPL (placental site trophoblastic tumour)
- p63 (epithelioid trophoblastic tumour)
- Ki-67
Clinical notes
- Abnormal bleeding after any pregnancy, or haemoptysis, neurologic signs or vaginal nodules in a woman of reproductive age, should prompt an hCG test.
- Choriocarcinoma is treated with chemotherapy, with very high cure rates; placental site and epithelioid tumours rely on hysterectomy.
Test yourself
Think of the answer, then tap the question to see it.
What distinguishes choriocarcinoma from an invasive mole under the microscope?
Choriocarcinoma has no chorionic villi, only sheets of malignant cytotrophoblast and syncytiotrophoblast; an invasive mole contains villi.
Where does gestational choriocarcinoma metastasise first?
Through the blood, most often to the lungs, then the vagina, brain and liver.
Which trophoblastic tumour has low hCG, stains for hPL and resists chemotherapy?
The placental site trophoblastic tumour.
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Gestational Trophoblastic Disease Treatment (PDQ®)–Health Professional Version (National Cancer Institute, 2026); Hydatidiform Mole (StatPearls (NCBI Bookshelf), 2026).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.