Chorionepithelioma

Chorionepithelioma - malignant tumor derived from epithelial cells of the chorion after or during pregnancy in the uterus, occasionally in the fallopian tubes, cervix of the uterus or ovary. Usually chorionepithelioma is formed in the field of placental site in the form of a knot growing in the uterus or in thickness her muscular layer, abdominal cover, occasionally in murine without the involvement of the endometrium. Microscopically chorionepithelioma consists of sharply atypical cells (type Langhans or syncytial). Chorionepithelioma destroys blood vessels, sooner spreads to the lungs, brain, vagina, liver and other organs.
The main symptom of horionepitelioma - emergence of bleeding, sometimes during pregnancy, but usually after its completion, directly or after some period of time (sometimes many years later, even with the onset of menopause). In most patients spotting occur nearly continuously and resume after scraping mucous membrane of the uterus; can be caused profuse bleeding. The uterus is in process of growth of the tumor grows, it becomes much too soft, uneven texture becomes irregular shape with rough surface. Pain in the lower abdomen, appear foul-smelling discharge from the genital tract, increased body temperature, increases in deficiency, and cachexia.
The diagnosis is based on the clinical picture of the disease, detection of human chorionic gonadotropin in the urine, which in horionepiteliome often much more than during normal pregnancy (see Elgama - Condeca reaction), and the results of the histological examination of a scraping of the uterus or remote tumor nodes (for example, from the vagina). Radiographically detected distant metastases horionepitelioma in the lungs, bones and so on; angiography (see) can detect a tumor in the uterus and abroad in the pelvic cavity, to determine the location and size.
Patients with suspected horionepiteliome should urgently be sent to the doctor.
Treatment. The main method is chemotherapy, sometimes in combination with surgery (hysterectomy with or without appendages) and beam method, sometimes only with radiation. The results depend primarily on the stage of the disease.

Chorionepithelioma (cliorionepithelioma; synonym: choriocarcinoma; blastoma deciduochoriocellulare, deciduoma, carcinoma serotinale) is a malignant tumor arising from items trophoblast; her usual localization is the body of the uterus, occasionally fallopian tubes, cervix and even more rarely ovaries. Special forms is very rare chorionepithelioma ceratoides type, developing in women outside sexual organs (lungs, liver) and men (in the testicle).
Chorionepithelioma included into the group of special diseases trophoblast, which include also the gallbladder drift (see), syncytial endometritis and destruida chorioadenoma. Frequency USSR diseases in different countries are different. They are especially common in Japan and the Philippines.
In European countries, chorionepithelioma average of about 2% of all malignant tumors of female genitals.
Chorionepithelioma arises and manifests itself in most of the patients in the first year after a previous pregnancy (but sometimes many years). Chorionepithelioma may begin during pregnancy, but clinical symptoms occur more often after its completion.
Chorionepithelioma occurs mostly (nearly 80% of cases) avtomobilnyh.
In most cases, the occurrence of horionepitelioma after the first pregnancy last proceeded pathologically (cystic drift) with frequent violation in the early period.
The age of patients horionepiteliome childbearing (80% to 40 years), but sometimes much more Mature, more than 60 years (with long-menopause), 20-30 years after the last pregnancy.
Pathological anatomy. Chorionepithelioma develops from epithelial cells of the chorion, most often on the former site of nedachi ovum, usually in the upper half of the body of the uterus or in one of its corners and looks bumpy nodes; less common diffuse growth. In addition, chorionepithelioma may occur in the fallopian tubes, vagina, ovaries. The nodes of the tumor can be singular and plural. Their consistence very soft, the cut they are spongy tissue dark red in color, slightly reminiscent of the past. Histological examination in horionepitelioma distinguish cell type Langhans (cytotrophoblast) and syncytial education (syncytiotrophoblast) with predominance of those or other elements. Tumor cells type Langhans of different sizes, round or polygonal in shape, with a light protoplasm and puzyrchatka nucleus (Fig. 1). They have a large number of figures division. Cell type Langhans form a massive fields of different sizes and shapes, on the periphery of which are syncytial elements. Kernel-latest sharply hyperchromia, irregular shape: round, elongated, cigar shaped with pointed ends (Fig. 2).
Sometimes visible sharp vacuolization of cytoplasm, figures division are rare.
In addition, there are transitions between cells type Langhans and syncytial elements: protoplasm their turns darker kernel become elongated, hyperchromic. Sometimes they are of huge size, bizarre forms with ugly hyperchromic cores. The tumor has not stroma and their vessels. Elements of horionepitelioma as trophoblast, have the ability to eat away at the walls of blood vessels, and the growth of tumors occur in the blood vessels of the uterus; this raises haemorrhage and thrombosis. The site of the tumor is essentially fibrinous-hemorrhagic mass, in which the tumor cells.
Distributed chorionepithelioma mainly through the blood vessels (intra - and extravasal). In part the growth of the tumor destroys the walls of blood vessels and infiltrates the surrounding tissue. Spreads chorionepithelioma into the lungs, vagina, brain, liver and other organs. Diagnosis of horionepitelioma in a remote uterus is quite simple. Diagnosis of horionepitelioma in scraping can present great difficulties, especially in case of the tumor out of a molar.
Chorionepithelioma can be observed in men. It appears in teratoblastoma of undifferentiated elements that accept features trophoblast and syncytiotrophoblast. Histological structure its the same as the above. Spreads chorionepithelioma of the testis in the retroperitoneal lymph nodes, lungs, liver, etc. However, the question about the identity of women and men horionepitelioma is controversial.
Ectopic chorionepithelioma found in the wall of the stomach, lungs, liver, ovaries, mediastinum and other organs. The origin of its unclear. Most likely it is teratornis education.

Fig. 1. Chorionepithelioma cell type Langhans (H).
Fig. 2. Chorionepithelioma cell type Langhans, syncytial elements and transitional forms (H).