Endometrial Cancer With Choriocarcinoma:Case Report And Review Of The Literature

Background:Collision tumors,where two tumor components are present simultaneously,is an uncommon presentation.There is a clear demarcation between two tumors of different composition.There have been multiple case reports of collisional tumors in various organs,including the ovary,uterus,skin,thyroid,lung,and digestive system.Endometrial cancer is the third most common cause of death in gynecological cancers,second only to ovarian cancer and cervical cancer.Choriocarcinoma is often considered a pregnancy-related gestational trophoblastic malignancy.The occurrence of endometrioid adenocarcinoma with choriocarcinoma differentiation is a very rare form of non-gestational tumors with trophoblastic differentiation.Only a few cases have been reported so far.Owing to the very low morbidity and dispersed distribution of this malignant tumor,large-scale clinical prospective studies cannot be performed.The treatment of endometrial cancer and gestational trophoblastic tumor is different,so the best therapy of endometrial cancer combined with choriocarcinoma remains unknown.The purpose of this study is to investigate the clinical features and treatment of endometrial carcinoma with choriocarcinoma,and to provide the foundation for future clinical diagnosis and therapy.Methods:We searched with key words of "endometrial choriocarcinoma differentiation","endometrial cancer with choriocarcinoma","second tumor endometrial cancer" in PubMed database.The published cases were combined with 2 cases from Qilu Hospital,Shandong University.Case 1 was a 54-year-old woman who presented to a doctor with postmenopausal vaginal bleeding and had elevated serum HCG.Gynecological examination showed cervical prolapse vegetation,pathological examination was choriocarcinoma.Vaginal bleeding recurred in patient 6 months after finishing chemotherapy.The patient underwent hysterectomy and adnexectomy.Pathological result was high-grade differentiated endometrioid adenocarcinoma.Immunohistochemistry:choriocarcinoma components ER(-),PR(-),HCG(+).The components of endometrial cancer were strongly positive for ER and PR,but negative for HCG.Case 2 was a perimenopausal 55-year-old woman who presented with abnormal vaginal bleeding and serum beta-HCG elevation.The patient experienced vaginal bleeding again during chemotherapy,and the pathology of diagnostic curettage suggested:endometrial dedifferentiated carcinoma.The patient underwent hysterectomy plus double adnexectomy plus pelvic metastases resection plus pelvic lymph node sampling.Postoperative pathology showed:endometrial dedifferentiated carcinoma,including well-differentiated adenocarcinoma and undifferentiated carcinoma.Sigmoid colon metastases show clear cell carcinoma images.Immunohistochemistry:Well differentiated adenocarcinoma was strongly positive for ER and PR,but negative for HCG;dedifferentiated carcinoma was negative for ER,PR and HCG;clear cell carcinoma was negative for ER and PR.Data analysis was performed on all the retrieved data.Results:The 31 patients ranged in age from 34 to 88 years.Of the 27 cases who provided pregnancy and parity,81.5%had a history of one time or more pregnancy.Most sufferers complain of postmenopausal vaginal bleeding.The most common somatic carcinoma histological type is EEC,with or without mucinous differentiation.The second most common type of associated pathology is adenocarcinoma or carcinoma without further specification.The lungs are the most frequent site of distant metastases.Other common metastatic sites include brain,bone,adrenal glands,retroperitoneal,liver,and peritoneum.Conclusion:1.The trophoblastic component may represent a dedifferentiated form of endometrial cancer.2.There is a correlation between the prognosis of patients and age factors.The correlation between FIGO staging,the proportion of choriocarcinoma components and prognosis still needs more data to be further analyzed.Fluctuations in HCG are also often associated with tumor recurrence,but have not been described in detail in previously reported cases.3.For these special types of tumors,the main treatment method is surgery combined with adjuvant chemotherapy.The choice of a specific chemotherapy regimen is still unknown.