Presence of Chorionic Villi Does Not Exclude Choriocarcinoma: A Case Report of Early Choriocarcinoma Associated with a Complete Hydatidiform Mole.

Background

Gestational choriocarcinoma is a highly aggressive trophoblastic neoplasm. Historically, the presence of chorionic villi was considered discordant with the diagnosis of choriocarcinoma. We report a case of early gestational choriocarcinoma arising in a post-molar setting with residual chorionic villi, creating a diagnostic pitfall. Case report: a 51-year-old woman with a prior complete hydatidiform mole showed plateauing β-human chorionic gonadotropin (ß-hCG) levels. She underwent total laparoscopic hysterectomy. Histologic examination of the uterine mass revealed a malignant biphasic-to-triphasic trophoblastic proliferation with marked atypia, brisk mitotic activity, extensive hemorrhage, and necrosis, situated immediately adjacent to a single residual molar villus. Immunohistochemistry showed strong β-human chorionic gonadotropin expression in syncytiotrophoblasts, a elevated Ki-67 index (∼80%), focal human placental lactogen (hpL) expression, and absence of p63 staining, confirming choriocarcinoma and excluding other trophoblastic tumors.

Conclusion

this case demonstrates that the presence of chorionic villi does not exclude a diagnosis of choriocarcinoma and underscores the necessity of rigorous clinicopathologic correlation.