A woman with gestational choriocarcinoma develops widespread disease. By which route does this tumour characteristically disseminate, and what is its most common metastatic site?

• A Lymphatic spread; para-aortic nodes
• B Haematogenous spread; lung ✓
• C Direct transcoelomic spread; ovary
• D Haematogenous spread; bone

Explanation

Gestational choriocarcinoma invades maternal venous sinuses early and disseminates haematogenously. The lung is the most frequently involved metastatic site, followed by the vagina, then brain and liver, which carry the worst prognosis. Lymphatic spread is distinctly uncommon, a feature separating choriocarcinoma from many other gynaecological malignancies. Pulmonary nodules causing haemoptysis are therefore a classic presenting picture of metastatic gestational trophoblastic neoplasia.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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