primary ovarian choriocarcinoma
Introduction
Introduction to primary ovarian choriocarcinoma Primary ovarian choriocarcinoma is a highly malignant ovarian tumor. Ovarian choriocarcinoma can be divided into gestational and non-pregnant choriocarcinoma. Pregnant choriocarcinoma is generally not associated with other malignant germ cell tumors. Mixed type is the presence of choriocarcinoma components in other malignant germ cell tumors, such as immature teratoma, yolk sac tumor, embryonal tumor and dysgerminoma. Primary ovarian choriocarcinoma is more common, and simple type is extremely rare. Pregnant choriocarcinoma is generally not associated with other malignant germ cell tumors. The diagnosis of these two types of choriocarcinoma is difficult to distinguish unless it occurs before menarche or if the virgin can be diagnosed as non-pregnant choriocarcinoma. In the past, it was considered that the prognosis of non-pregnant choriocarcinoma was worse than that of gestational choriocarcinoma. The disease progressed rapidly and died in a short period of time. basic knowledge The proportion of sickness: 0.003%-0.005% Susceptible people: women Mode of infection: non-infectious Complications: ascites
Cause
Primary ovarian choriocarcinoma
(1) Causes of the disease
Primary ovarian choriocarcinoma is derived from pluripotent cells in ovarian germ cells to extraembryonic structures (trophoblasts or yolk sacs, etc.). Pregnancy choriocarcinoma is caused by malignant transformation of gestational trophoblast cells. Most of it is transferred from the uterus, tubal pregnancy choriocarcinoma, and rarely from ovarian pregnancy.
(two) pathogenesis
Characteristics of primary ovarian choriocarcinoma: the tumor is mostly unilateral, the right side is more common than the left side, and the tumor is 8 to 30 cm in diameter. It is a capsule, solid, soft, brittle and brittle hemorrhagic mass. Mostly brown-red, with extensive bleeding, necrosis, often found a small amount of surviving tumor tissue at the edge of the tumor, the morphology is the same as uterine choriocarcinoma, such as mixed type can appear other germ cell tumor morphology.
1. Microscopic: There is a cord or reticular structure composed of a mixture of cytotrophoblasts and syncytiotrophoblasts. The syncytiotrophic cells secrete HCG. The microscopic morphology is also the same as that of uterine choriocarcinoma. It is composed of cytotrophoblasts and syncytiotrophoblasts. Other germ cell tumors, especially embryonal carcinomas, often have unequal amounts of syncytial cells, and the diagnosis must have both trophoblasts.
2. The typical tumor of choriocarcinoma is large, unilateral, solid, soft, bleeding, necrotic, and the morphology is similar to uterine choriocarcinoma. If it is mixed, the morphology of other germ cell tumors may appear.
3. Metastasis: mainly for the transfer of blood to the whole body organs, the most common metastatic site is the lung, followed by the liver, brain, kidney, gastrointestinal and pelvic organs. The lymphatic metastasis of non-pregnant choriocarcinoma is more than that of pregnancy choriocarcinoma. see.
Prevention
Primary ovarian choriocarcinoma prevention
Focus on early detection of tumors, whether benign or malignant early patients, often no obvious symptoms, benign tumors have malignant potential, should conduct a regular survey.
Complication
Primary ovarian choriocarcinoma complications Complications ascites
Due to the rapid growth of the tumor, a large amount of consumption causes the patient to be extremely weak and the cachexia to occur earlier.
Symptom
Primary ovarian choriocarcinoma common symptoms luteinized cyst fever vaginal bleeding abdominal pain abdominal mass pelvic mass abdomen blood ascites
1. Abdominal performance: Abdominal pain, abdominal mass is the most common symptom. Abdominal pain may be caused by tumor hemorrhage, necrosis, and acute abdominal pain due to tumor rupture.
2. Irregular vaginal bleeding: Irregular vaginal bleeding is due to the secretion of HCG (chorionic gonadotropin) in ovarian choriocarcinoma, often accompanied by functional interstitial, ie, interstitial luteinization. The endometrium may have a decidual reaction.
3. Fever: up to 38 ~ 39 ° C, fever may be due to tumor bleeding, necrosis or infection.
4. Sexual precocity: Pre-puberty can occur as a precocious puberty.
5. Pelvic examination: pelvic or abdominal mass can be found, the size is different, the capsule mass is often accompanied by bloody ascites.
Examine
Examination of primary ovarian choriocarcinoma
1. Tumor marker examination.
2. Hormone level check: Blood or urinary human chorionic gonadotropin titer increased, 5 cases of HCG (+) in 6 cases reported by Axe, 2 cases of urinary HCG (+) in 8 cases of Peking Union Medical College Hospital, another 6 The blood HCG is 250081400mU/ml. HCG is produced by syncytiotrophoblasts. AFP (alpha-fetoprotein) elevation is only positive when mixed with yolk sac tumor.
3. B-ultrasound: A metastatic tumor that can show solid liver mass. In Peking Union Medical College Hospital, 1 case of renal pelvis is enlarged due to large tumor, and B-ultrasound shows hydronephrosis.
4. X-ray examination: chest radiographs can show shadows when there is lung metastasis, and 5 cases of lung metastases in 8 cases of Peking Union Medical College Hospital.
5. CT examination: CT scan can show the presence or absence of brain metastasis, abdominal CT can show solid lesions of the liver.
6. Laparoscopy.
7. Histopathological examination.
Diagnosis
Diagnosis and diagnosis of primary ovarian choriocarcinoma
diagnosis
Primary ovarian choriocarcinoma has some characteristics in clinical manifestations, such as young age of onset, especially in women before puberty, pelvic mass growth is fast, accompanied by abdominal pain or irregular vaginal bleeding, prone to ascites, accompanied by fever, Should first consider the detection of germ cell tumors, especially serum HCG radioimmunoassay, the increase in titer is large, should consider the diagnosis of choriocarcinoma, in order to distinguish between simple or mixed ovarian cancer, serum AFP can be measured simultaneously, such as AFP There are also elevated, should be considered mixed with yolk sac tumor components, other can also be mixed with immature teratoma or dysgerminoma, liver, spleen, kidney and pelvic B-ultrasound, skull and pelvic CT, lung X-ray or CT You can see if there are other organ metastases, such as lung, liver, spleen, kidney, brain and retroperitoneal lymphatic metastasis.
Differential diagnosis
Age is related to the identification of gestational and non-pregnant ovarian choriocarcinoma. It can be positively diagnosed as non-pregnant choriocarcinoma before puberty, but it is often difficult for women of reproductive age to distinguish from gestational choriocarcinoma. In the development of molecular biology, genetic polymorphism can be determined by PCR (polymerase chain reaction) method to identify pregnancy and non-pregnant choriocarcinoma from tumor DNA analysis.
