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Characteristics of gestational trophoblastic neoplasia

Characteristics of gestational trophoblastic neoplasia
  Choriocarcinoma and intraplacental choriocarcinoma PSTT ETT
Fetus
  • Varies: Absent in complete hydatidiform mole, but present for all others*
  • May follow antecedent pregnancy by months to years*
  • May follow antecedent pregnancy by months to years*
Cytotrophoblasts
  • Atypical, highly proliferative*
    
Syncytiotrophoblasts
  • Atypical*
    
Implantation site extravillous (intermediate) trophoblasts  
  • Present*
  
Chorionic membranous extravillous (intermediate) trophoblasts    
  • Present*
Chorionic villi
  • Usually absent
  • Usually absent
  
Biological potential
  • Invasive and metastatic
  • Invasive and metastatic in approximately 30 to 50% of cases
  • Invasive and metastatic
Differential diagnosis
  • Non-gestational gonadal (ovarian) cell-derived choriocarcinoma
  • Somatic high-grade malignant neoplasm
  • "Exaggerated" normal implantation site (Ki-67 proliferation index <5%)
  • Atypical implantation site (Ki-67 proliferation index between 5 and 10%)
  • Molar implantation site (molar chorionic villi present elsewhere)
  • High-grade non-gestational epithelioid malignant neoplasm
  • Rarely mixed PSTT and concurrent choriocarcinoma
  • Atypical placental site nodule (Ki-67 proliferation index between 5 and 10%)
  • Cervical squamous cell carcinoma (when tumor arises in the cervix or lower uterine segment)
  • High-grade non-gestational epithelioid malignant neoplasm
  • Rarely mixed ETT and concurrent choriocarcinoma
Typical genetics
  • Biparental disomy
  • Diandric (46,XX) when derived from complete hydatidiform mole
  • 46,XX
  • 46,XX
Key marker status
  • SALL4-positive; strong staining for beta-hCG in syncytiotrophoblasts
  • CD146 (Mel-CAM)- and hPL-positive, p63-negative, Ki-67 proliferation index >10%
  • CD146 (Mel-CAM)-negative or patchy, p63- and PLAP-positive, Ki-67 proliferation index >10%

ETT: epithelioid trophoblastic tumor; GTN: gestational trophoblastic neoplasia; hCG: human chorionic gonadotropin; hPL: human placental lactogen; PLAP: placental alkaline phosphatase; PSTT: placental site trophoblastic tumor.

* Denotes features that are typically present.
Graphic 144319 Version 1.0

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