ABSTRACT
The pathogenesis of mixed endometrial adenocarcinoma with trophoblastic differentiation is quite unclear at times. The present study examines a serous carcinoma with choriocarcinomatous differentiation. p53 staining was seen in the serous component and the cytotrophoblastic cells of the choriocarcinomatous component, but not in the syncytiotrophoblastic cells. p53 mutational analysis showed a heterozygotic mutation at exon 8 for the choriocarcinomatous component and a homozygote deletion at exon 7 for the serous component. These alterations suggest that the multidirectional tumor differentiation might occur from a common stem cell in these malignancies.
Subject(s)
Adenocarcinoma/genetics , Choriocarcinoma/genetics , Endometrial Neoplasms/genetics , Neoplasms, Multiple Primary/genetics , Trophoblastic Neoplasms/genetics , Tumor Suppressor Protein p53/genetics , Adenocarcinoma/metabolism , Adenocarcinoma/pathology , Base Sequence , Biomarkers, Tumor/metabolism , Cell Lineage , Cell Nucleus/metabolism , Choriocarcinoma/metabolism , Choriocarcinoma/pathology , DNA Mutational Analysis , DNA, Neoplasm/analysis , Endometrial Neoplasms/metabolism , Endometrial Neoplasms/pathology , Female , Humans , Middle Aged , Molecular Sequence Data , Neoplasms, Multiple Primary/metabolism , Neoplasms, Multiple Primary/pathology , Stem Cells , Trophoblastic Neoplasms/metabolism , Trophoblastic Neoplasms/pathology , Tumor Suppressor Protein p53/metabolismABSTRACT
Nongestational choriocarcinomas rarely occur outside the gonads or teratomas. We report a serous carcinoma of the endometrium with a choriocarcinomatous component and review of the literature. A 61-year-old woman underwent hysterectomy and bilateral salpingo-oophorectomy for a serous carcinoma with choriocarcinomatous component. Immunohistochemistry showed a strong p53 staining of the serous component and the cytotrophoblastic cells of the choriocarcinomatous component; the syncytiotrophoblast was negative. The initial serum human chorionic gonadotropin (hCG) was 225,000 IU/L. Postoperatively, the patient developed diffuse pulmonary metastatic disease. Despite chemotherapy, the patient died 2 months after initial diagnosis. Abstracting the data from the reported cases and from the literature, it can be assumed that 2 different tumor types exist. The first one is morphologically and clinically more related to the gestational choriocarcinoma with strongly elevated serum hCG levels, early onset of (distant) metastatic disease, and consecutively rapid and often fatal clinical course. The second type presents as an endometrial carcinoma with single syncytiotrophoblast-like cells, associated with low serum hCG, no distant metastatic disease, and, consequently, a better prognosis. The prognostically relevant component for long-time survival in the latter variant is the nontrophoblastic component.