Choriocarcinoma is a highly malignant tumor arising from the chorionic epithelium. It should be remembered that it is not a tumor of the uterus which is secondarily involved.
About 3–5 percent of all patients with molar pregnancies develop choriocarcinoma. Amongst all patients with choriocarcinoma, around 50 percent develop following a hydatidiform mole, 30 percent occur after a miscarriage or an ectopic pregnancy and 20 percent after an apparently normal pregnancy. Trophoblastic disease following a normal pregnancy is either choriocarcinoma or PSTT and not a benign or invasive mole.
Pathology: The primary site is usually anywhere in the uterus. Rarely, it starts in the tube or ovary. Ovarian choriocarcinoma (non-gestational) may also be associated with malignant teratoma or dysgerminoma.
NAKED EYE APPEARANCES: -
The lesion is usually localized nodular type. It looks red, hemorrhagic and necrotic. At times, the lesion is diffuse involving the entire endometrium. The nodular type may be located deep in the myometrium with overlying endometrium intact. This often gives the false-negative diagnosis on uterine curettage.
MICROSCOPIC APPEARANCE: -
There are anaplastic sheets or columns of trophoblastic cells invading the uterine musculature. There are evidences of necrosis and hemorrhage. Villus pattern is completely absent.
OVARIAN ENLARGEMENT: Bilateral lutein cysts are present in about 30 percent. These are due to excessive production of chorionic gonadotropin.
Spread of GTN: Apart from the local spread, vascular erosion takes place early and hence distant metastases occur rapidly. The common sites of metastases are lungs (80%), anterior vaginal wall (30%), brain (10%), liver (10%) and others.
CLINICAL FEATURES OF CHORIOCARCINOMA
The clinical features depend on the location of the primary growth and on its secondary deposits.
Patient profile: There is usually a history of molar pregnancy in recent past. Rarely, its relation with a term pregnancy, abortion or ectopic pregnancy may be established. GTN after a non-molar pregnancy is always a choriocarcinoma.
SYMPTOMS OF CHORIOCARCINOMA :
- Persistent ill health.
- Irregular vaginal bleeding, at times brisk.
- Continued amenorrhea.
Other symptoms due to metastatic lesions are:
Lung: Cough, breathlessness, hemoptysis.
Vaginal: Irregular and at times brisk hemorrhage.
Cerebral: Headache, convulsion, paralysis or coma.
Liver: Epigastric pain, jaundice.
SIGNS FOR CHORIOCARCINOMA
- Patient looks ill.
- Pallor of varying degrees.
Physical signs are evident according to the organ involved. Bimanual examination reveals subinvolution of the uterus. There may be a purplish red nodule in the lower-third of the anterior vaginal wall. Unilateral or bilateral enlarged ovaries may be palpable through lateral fornices.
HOMOEOPATHIC MANAGEMENT OF CHORIOCARCINOMA
The Homeopathic mode of system is based upon the basis of individualization. Homoeopathic medicines are based on symptoms similarity. Homeopathic physicians mostly consider the miasmatic cause of the disease and they help in improving immunity.
The medicines that can be thought of:-
- Sabal serrulata
- Thuja etc.