Chorionepithelioma is a malignant tumor that grows in the uterus from the trophoblast of a developing blastocyst and manifests itself after hydatidiform mole, abortion, or during normal pregnancy. It retains the invasive nature of the growth of a normal placenta, is able to secrete HCG. In the initial stages, it grows slowly and can be treated. Frequency

    • Chorionepithelioma in 20% of cases develops with complete mole
    • May develop in the setting of hydatidiform mole (50%), normal pregnancy (25%), miscarriage, or ectopic pregnancy (25%)
    • A relationship was found between the frequency of development of chorionepithelioma and the blood types of sexual partners: women – A (I), men – O (I).

Clinical picture

    • Pathological uterine bleeding in chorionepithelioma can appear quite quickly or several years after pregnancy, and bleeding from damaged areas of the lower genital tract can begin at any time.
    • Metastases are found in the gastrointestinal tract, genitourinary system, liver, lungs and brain, metastasis is often accompanied by bleeding due to the tropism of the tumor tissue to the vessels.
    • Depending on the nature of the course, gestational trophoblastic neoplasia is divided into metastatic and non-metastatic.
    • Non-metastatic gestational trophoblastic neoplasia is the most common form of the disease and only affects the uterus.
    • Metastatic gestational trophoblastic neoplasia is a disease that spreads outside the uterus. Symptoms depend on the location of metastases (for example, hemoptysis with lung metastases, neurological symptoms with brain metastases).
    • Metastatic gestational trophoblastic neoplasia with a favorable prognosis – a short duration of the disease (less than 4 months have passed since pregnancy), low HCG titer before treatment (less than 40,000 mIU / ml), no metastatic brain and liver damage, no history of chemotherapy.
    • Metastatic gestational trophoblastic neoplasia with an unfavorable prognosis – a long duration of the disease (more than 4 months have passed since pregnancy), a high titer of HCG before treatment (more than 40,000 mIU / ml), metastatic brain or liver damage, ineffectiveness of previous chemotherapy.


    • Determination of HCG content
    • X-ray examination of the chest organs
    • Intravenous pyelography
    • KG liver
    • Blood test (clinical and biochemical)
    • Ultrasound of the pelvic organs
    • Determination of the marker of chorionepithelioma – B-choriogonin.


Non-metastatic gestational trophoblastic neoplasia is treatable in almost 100% of cases.

    • Chemotherapy. Several treatment regimens are used:
    • Methotrexate 30 mg/m2 intravenously and 1 r/week until HCG titer normalizes; daunorubicin (rubomycin hydrochloride), dactinomycin; vinblastine; platinum products, etc.
    • Methotrexate 1 mg/kg every other day for 4 days followed by intravenous leucovorin (0.1 mg/kg) for 24 hours after methotrexate (effective in 90%).
    • Intermittent courses of therapy continue up to three negative test results for the presence of HCG, conducted 1 r / week.
    • If chemotherapy is ineffective, a hysterectomy (secondary hysterectomy) is indicated.
    • If the patient does not want to have babies, a hysterectomy is performed during the first course of chemotherapy (primary hysterectomy).
    • After the end of the course of chemotherapy, pregnancy occurs in 50% of women interested in having a child. In 80-85% of cases, children are born healthy.

Metastatic gestational trophoblastic


    • Metastatic gestational trophoblastic neoplasia with a favorable prognosis. Treatment is carried out longer than with non-metastatic gestational trophoblastic neoplasia, with the same products.
    • After obtaining negative HCG titers, one is prescribed

additional course of chemotherapy.

    • If resistance to methotrexate occurs (i.e., there is an increase or maintenance of a constant level of HCG titer) or after the 5th course of chemotherapy, the titers are still positive, the patient is transferred to treatment with actinomycin D (dactinomycin).
    • If resistance to both drugs occurs, a combined course of treatment is prescribed – methotrexate, dactinomycin, and chlorambucil (chlorbutin). Also used are adriamycin (doxorubicin hydrochloride), bleomycin, platinum products, vinblastine, vincristine.
    • Indications for hysterectomy are the same as for non-metastatic gestational trophoblastic neoplasia.
    • Metastatic gestational trophoblastic neoplasia with poor prognosis. Patients are traditionally less susceptible to chemotherapy, especially during repeated courses. In addition, the condition of the patients is aggravated by severe intoxication and depletion of the functions of the red bone marrow.
    • Combination chemotherapy with various products is needed, probably the addition of radiation therapy.
    • EMA-CO (etoposide, methotrexate, and actinomycin D [dactinomycin] alternating with cyclophosphamide [cyclophosphamide] and oncovin [vincristine]).
    • MAC (methotrexate, actinomycin D and cyclophosphamide) are given in cycles of 3 weeks until complete remission.
    • ;> Other regimens: cisplastin, bleomycin and vinblastine; cis-

plates, etoposide and bleomycin.

    • Treatment is carried out in specialized centers, especially with severe intoxication. A second course of treatment begins after 2-3 weeks.
    • The frequency of remission is within 66%; after chemotherapy in combination with radiation therapy, the prognosis is the best. If there is a need for a hysterectomy, the prognosis is worse. Criteria for recovery: restoration of menstrual function, reduction in the size of the uterus to normal, the disappearance of HCG from blood serum and urine.


    • Non-metastatic gestational trophoblastic neoplasia and metastatic gestational trophoblastic neoplasia with a favorable outcome
    • A woman is discharged after three normal HCG tests performed 1 week apart.
    • Determination of HCG titer 1 r / 2 weeks for 3 months, then 1 r / month for 3 months, then 1 r / 2 months for 6 months, then 1 r / 6 months for 2 years
    • Regular pelvic exam
    • Chest x-ray at 3 months for 1 year
    • Contraception (traditionally with oral contraceptives) for 1 year.
    • Metastatic gestational trophoblastic neoplasia with poor prognosis
    • The patient is discharged after three negative tests for HCG, carried out with an interval of 1 week
    • HCG titer is determined 1 r/2 weeks for 3 months, then 1 r/month for 1 year, then 1 r/6 months for 4-5 years
    • Chest x-ray is performed after 3 months
    • Oral contraceptives are prescribed until tests for HCG are negative within 1 year.

Recurrence rate

    • Non-metastatic gestational trophoblastic neoplasia – 2%
    • Metastatic gestational trophoblastic neoplasia with a favorable prognosis – 5%
    • Metastatic gestational trophoblastic neoplasia with a poor prognosis – 21%.

Prevention – rational treatment of hydatidiform mole with the appointment of anticancer drugs according to indications. Synonyms

    • Choriocarcinoma
    • Disease malignant gestational trophoblastic
    • Trophoblastic neoplasia See also Skid cystic ICD. D39.2 Malignant neoplasm of placenta

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