Ovarian carcinomas with choriocarcinomatous differentiation.

Abstract

Ovarian carcinomas may produce human chorionic gonadotropin (HCG) or HCG-like substances and may even contain syncytiotrophoblast cells, but a true choriocarcinomatous component has not been described in these tumors. Two cases of poorly differentiated ovarian carcinoma with choriocarcinomatous components are reported. Pathologic findings were correlated with immunohistochemical stains, hormonal effects, and clinical behavior. Each tumor contained a circumscribed, extensively necrotic and hemorrhagic brown nodule. Microscopically, the nodules exhibited a mixture of cytotrophoblast and syncytiotrophoblast. The syncytiotrophoblast capped cytotrophoblast and was strongly positive for beta-HCG. In one of the cases, a transformation zone composed of poorly differentiated carcinoma with occasional beta-HCG-positive cells was observed between a mucinous cystadenoma and the choriocarcinomatous elements. The two cases exhibited activation of the ovarian stroma in the form of condensation and luteinization. Extra-abdominal metastases developed early in both patients and, despite multiagent chemotherapy, they died shortly postoperatively. Choriocarcinoma may rarely develop as a result of dedifferentiation of common epithelial ovarian tumors. Recognition of choriocarcinomatous components in ovarian carcinomas is important because of its association with aggressive behavior.