Postpartal gestational choriocarcinoma fatally misdiagnosed as squamous cell cancer of the uterine cervix.

Abstract

Gestational choriocarcinoma (CCA) is a well-defined tumor, but there may be a surprising variation in its morphologic appearance. A 33-year-old woman with term-pregnancy six months before presented with dysfunctional bleedings that lasted about five weeks. Cervical punch biopsy and currettage revealed a polymorphic tumor which was initially diagnosed as poorly differentiated squamous cell cancer of the cervix. Methotrexat monochemotherapy was performed after histology definitely revealed CCA on the radical abdominal hysterectomy-specimen (Wertheim-Meigs). Immediately after HE, the patient developed diffuse pulmonary metastases and died of respiratory insufficiency after two courses of MTX-therapy. The autopsy confirmed metastatic CCA. The second patient, a 48-year-old women with pregnancy 24 years before, was initially treated with radical HE after misdiagnosis of cervical currettage as squamous cell cancer of the uterine cervix. The patient showed complete remission after two courses of medium risk-protocol and seven courses of high risk-protocol (CHAMOCA). All cervical curettage specimens which did not show typical squamous cell cancer. even in older women, were suspicious of CCA. CCA often shows degenerative changes or predominantly intermediate or cytotrophoblastic cellular elements. To detect the cells of most diagnostic value in CCA, the syncytiotrophoblastic elements, HCG-immunohistochemistry may be helpful.