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Case Reports
. 2022 Oct 13;17(1):79.
doi: 10.1186/s13000-022-01262-z.

Uterine choriocarcinoma arising from serous carcinoma in a postmenopausal woman: an analysis of next-generation sequencing and PD-L1 immunochemistry

Meiping Li  1 , Lei Bao  2 , Bo Lu  2 , Wenshun Ge  2 , Lifang Ren  2
Affiliations
Case Reports

Uterine choriocarcinoma arising from serous carcinoma in a postmenopausal woman: an analysis of next-generation sequencing and PD-L1 immunochemistry

Meiping Li et al. Diagn Pathol. .

Abstract

Background: Uterine somatic choriocarcinoma is a rare, clinically aggressive malignant tumor. They frequently concur with other cancer. However, the molecular pathogenesis between somatic choriocarcinoma and the concurrent carcinoma has rarely been addressed to date.

Case presentation: We report a 68-years old Chinese woman with a uterine choriocarcinoma arising from serous carcinoma. The patient underwent radical surgery including total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy and pelvic lymph node resection. She received 10 courses of post-operative chemotherapy. She died of disease 13 months after her surgery. Microscopically, the tumor showed a biphasic pattern of choriocarcinoma and serous carcinoma. The choriocarcinomatous component showed a combination of cytotrophoblast, intermediate trophoblast and syncytiotrophoblast with hemorrhage and necrosis. The component of serous carcinoma was characterized by solid sheets of small cells with marked nuclear atypia and occasional glandular and papillary formation. PD-L1 was exclusively expressed in the choriocarcinomatous component. Next-generation sequencing revealed that the genetic abnormalities were overlapping between the two components.

Keywords: Choriocarcinoma; Endometrium; Next-generation sequencing; PD-L1; Serous carcinoma.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A Multiple nodular masses (the red arrow) with hemorrhage and necrosis were found in the uterine cavity B: The cut surface was pale gray and brown. The tumor penetrated the entire uterine wall (the red arrow) C: The tumor was consisted of serous carcinoma (upper) and choriocarcinoma (below). (Hematoxylin and eosin stain, original magnification, × 100)
Fig. 2
Fig. 2
A Serous carcinoma showed glandular, papillary formation, and solid sheets. (Hematoxylin and eosin stain, original magnification, × 100) B: Serous carcinoma showed marked nuclear atypia, distinct nucleoli and frequent mitotic figures. (Hematoxylin and eosin stain, original magnification, × 400) C: Aberrant p53 over-expression in serous carcinoma. (The immunohistochemical stain, original magnification, × 50) D: High Ki67 index in srous carcinoma. (The immunohistochemical stain, original magnification, × 50) E: Positive IMP3 in srous carcinoma. (The immunohistochemical stain, original magnification, × 100) F: Negative ER in srous carcinoma. and CC. (The immunohistochemical stains, original magnification, × 100)
Fig. 3
Fig. 3
A Choriocarcinoma was consisted of mononucleate and multinucleate trophoblastic cell accompanied by extensive necrosis. (Hematoxylin and eosin stain, original magnification, × 100) B: Higher magnification of CC. (Hematoxylin and eosin stain, original magnification, × 400) C: Positive SALL4 in CC but negative in srous carcinoma. (The immunohistochemical stains, original magnification, × 100) D: Positive GATA3 in CC. (The immunohistochemical stains, original magnification, × 200) E: Positive HCG in CC. (The immunohistochemical stains, original magnification, × 200) F: PD-L1 positive in CC. (The immunohistochemical stain, original magnification, × 400)
Fig. 4
Fig. 4
Common and difference of different gene changes in ESC with CC differentiation
See this image and copyright information in PMC

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