J Korean Med Sci.  2005 Aug;20(4):683-686. 10.3346/jkms.2005.20.4.683.

Cutaneous Metastasis of Choriocarcinoma: A Case Report

• Park SG
• Chang JY
• Kim SH
• Bang D

• KMID: 1712756
• DOI: http://doi.org/10.3346/jkms.2005.20.4.683

Abstract

Choriocarcinoma is one of the malignant tumors of trophoblastic cells characterized by the secretion of human chorionic gonadotrophin (hCG) (1-3). Cutaneous metastasis is a rare presentation of choriocarcinoma but a poor prognostic sign because it is associated only with widespread disease (3-5). A 52-yr-old female complaining of dyspnea for 2 months, presented with fingertip sized erythematous nodules on the left side of the neck and the right side of the upper back of 1 month duraton. She has suffered from Behcet's disease since 1999. Microscopic examination of a nodule of upper back demonstrated biphasic pattern of cytotrophoblasts and hCG-positive syncytiotrophoblasts, and the typical histologic features of choriocarcinoma. She was referred to the gynecological oncology department. After 17 cycles of combination chemotherapy, the serum hCG level has fallen from 700,000 to under 2.0 mIU/mL and the skin lesions have almost disappeared. However, after 3 months, total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed due to elevated serum hCG level (4,447.7 mIU/mL), and she is scheduled to receive post-operative adjuvant chemotherapy.

Keyword

Choriocarcinoma; Neoplasm Metastasis

MeSH Terms

Choriocarcinoma/blood/*pathology
Chorionic Gonadotropin/blood
Female
Humans
Middle Aged
Pregnancy
Skin Neoplasms/*secondary
Uterine Neoplasms/blood/*pathology

Figure

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  Fig. 1 Fingernail sized erythematous nodules. (A) left side of neck, (B) right side of upper back.

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  Fig. 2 (A) Several hemorrhagic foci and multiple cellular infiltration throughout the dermis (hematoxylin and eosin, ×40). (B) Infiltrated tumor cells are composed of two populations of cells. One element exhibits clear cytoplasm and large, vesicular nuclei with prominent nucleoli, which is identified as cytotrophoblasts. The other cell population shows eosinophilic cytoplasm with cytoplasmic vacuoles and many dark nuclei, which is identified as syncytiotrophoblasts (hematoxylin and eosin, ×200). (Inset) hCG was positively stained in the cytoplasm of syncytiotrophoblasts but not the cytotrophoblasts (hCG stain, ×400).

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  Fig. 3 Abdomen pelvis MR images shows a protruding mass from low uterine cavity to vaginal canal (short arrow) and diffuse enlargement of uterus body showing heterogenous signal intensity, suggesting myometrial invasion (long arrow).

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