Gestational trophoblastic tumors include 3 well-defined pathologic entities: gestational choriocarcinoma
, placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT).
We performed targeted capture sequencing covering 1021 cancer-related genes because little is known about the mutation profiles of choriocarcinomas
Nonseminoma germ cell tumors include embryonic and extraembryonic components and are classified as embryonal cell carcinoma, choriocarcinoma
, yolk sac tumor, and teratoma (3,4).
The first group includes choriocarcinoma
and testicular malignancies taking on a cytotrophoblast histology (NSGCTs) producing hyperglycosylated hCG (hCG-h) in early and advanced stages (16, 17).
Given the high level of beta-hCG and normal level of AFP, a germinoma, choriocarcinoma
, or mixed type tumor was taken into account.
Table 1: Distribution of cases of AUB according to histological pattern Histological diagnosis Total number of cases (N=1545) (%) Proliferative phase 117 (7.6) Secretory phase 372 (24.1) Products of conception 62 (4.0) Simple hyperplasia without atypia 350 (22.6) Complex hyperplasia without atypia 42 (2.7) Hyperplasia with atypia 03 (0.2) Endometrial polyps 127 (8.2) Atrophic endometrium 52 (3.4) Hydatidiform mole 75 (4.9) Irregular ripening of endometrium 301 (19.5) Endometritis 13 (0.8) Endometrial carcinoma 28 (1.8) Choriocarcinoma
03 (0.2) Total 1545 (100)
Table 1: Morphological classification of ovarian neoplasms Sest Germ cell Sex cord stromal Metastatic Serous Teratoma: Granulosa cell Krukernberg/drop Mature/ immature Mucinous Dysgerminoma Fibrous tumor Loco-regional metastasis Endometrioid Endodermal sinus sclerosing stromal cell (yolk sac) cell Clear cell Choriocarcinoma
sertoli-stromal cell (leydig) Brenner Embryonal cell Steroid cell Undifferentiated Struma ovarii
is a rapidly growing, highly invasive and widely metastasizing human chorionic gonadotropin (hCG)-producing epithelial tumor with differentiation towards a villous trophoblast phenotype.
Common tumor markers associated with germ cell malignancies Benign Dysgerminoma Immature Endodermal teratoma teratoma sinus tumor AFP - - +/- ++ HCG - +/- - - LDH - ++ - +/- Estradiol - +/- +/- - PLAP * - ++ - - Embryonal Nongestational tumor choriocarcinoma
AFP +/- - HCG ++ ++ LDH +/- +/- Estradiol +/- - PLAP * - - ++ Present +/- Occasionally present, reported - Not present at discriminatory levels or reported outside of case reports * placental alkaline phosphatase Source: Berek & Hacker's Gynecologic Oncology, Comprehensive Gynecology, Cancer Treat Rev.
Our results indicate that VNTR genotyping, a relatively simple, reliable, cost-efficient and rapid procedure, can be used successfully for diagnosis of HM and distinguishing CHM from its mimics, which is clinically important because the majority of persistent trophoblastic diseases and choriocarcinomas
arise from CHM.
LC: Lung Cancers; UCB: Urothelial Carcinoma of the Bladder; GC: Gestational Choriocarcinomas
; ESCCs: Esophageal Squamous Cell Cancers; HOTs: Human Ovarian Tumors.
and bimorphic tumor types secrete only low levels of [beta]-hCG .