A 26-year-old woman with secondary amenorrhoea has a 8 cm solid left ovarian mass. Serum beta-hCG is 45,000 mIU/mL and urine pregnancy test is positive, but there is no intrauterine or extrauterine gestation on imaging. Hysterectomy specimen histology shows sheets and syncytia of malignant cytotrophoblast and syncytiotrophoblast with haemorrhage and necrosis, and no chorionic villi anywhere. Which statement best supports the final diagnosis?

• A Absence of chorionic villi establishes a non-gestational (ovarian) choriocarcinoma ✓
• B Presence of chorionic villi confirms gestational trophoblastic disease
• C Elevated beta-hCG alone proves ectopic pregnancy
• D Syncytiotrophoblast indicates a yolk sac tumour component

Explanation

Non-gestational choriocarcinoma is a malignant germ cell tumour of the ovary composed of cytotrophoblast and syncytiotrophoblast without any chorionic villi, and it secretes beta-hCG. The absence of villi excludes a gestational trophoblastic event and identifies the lesion as germ cell in origin. Syncytiotrophoblast cells can also appear scattered in dysgerminoma, but a pure choriocarcinoma pattern with villi absent defines this entity. These tumours are highly chemosensitive to etoposide-based regimens.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.