The specimen was removed surgically from a 36 year old woman with 3 children, the youngest aged 2 months. She was admitted to hospital with menorrhagia and an offensive vaginal discharge. On clinical examination she was pale and the uterus was enlarged and soft and there was a mass 5 cm. in diameter in the posterior wall of the vagina near the outlet. A total hysterectomy and excision of the vaginal mass was performed. Histology revealed choriocarcinoma of the uterus. The vaginal mass was a metastasis. There was initial post-operative recovery, but the patient died of metastatic disease 5 weeks after admission.
The uterus has been sliced sagittally and mounted to display the cut surface. In the wall of the fundus there is an irregular haemorrhagic focally necrotic mass which bulges into the uterine cavity. The tumour is not encapsulated. It is surrounded by smaller satellite lesions some of which may be blood vessels invaded by the tumour.
Choriocarcinoma is a highly malignant germ cell tumour which usually follows an abnormal pregnancy with a hydatidiform mole. It may also occur after a spontaneous abortion, and rarely, may follow a normal pregnancy. The tumour metastasizes early, by means of vascular invasion and blood spread. Macroscopically it is characteristically haemorrhagic and necrotic, due to vascular invasion. Histologicallly it is composed of 2 types of malignant cells, which resemble the cytotrophoblast and syncytiotrophoblast of normal placental chorionic villi. With surgery above the prognosis was poor, as illustrated by the above Clinical History. With the addition of modern cytotoxic chemotherapy, the prognosis has improved greatly (>80 over 5 years survived).