Six weeks after a normal vaginal delivery, a 26-year-old woman develops hemoptysis and vaginal bleeding. Serum beta-hCG is markedly elevated. Curettage shows pleomorphic cytotrophoblast and multinucleate syncytiotrophoblast forming a biphasic pattern with extensive hemorrhage and necrosis, but no chorionic villi. What is the diagnosis?

• A Gestational choriocarcinoma ✓
• B Invasive hydatidiform mole
• C Placental site trophoblastic tumor
• D Placenta accreta spectrum disorder

Explanation

Gestational choriocarcinoma is a malignant epithelial tumor of trophoblast defined by a biphasic population of atypical cytotrophoblast and syncytiotrophoblast, absence of chorionic villi, and marked hemorrhage and necrosis. It spreads early via the bloodstream, commonly to lungs, and produces very high beta-hCG. Invasive mole retains chorionic villi invading myometrium, and placental site trophoblastic tumor is monomorphic with low hCG.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.