J Clin Gynecol Obstet

Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc

Journal website https://www.jcgo.org

Case Report

Volume 9, Number 3, September 2020, pages 53-59

High-Grade Serous Carcinoma of Ovary With Choriocarcinomatous Differentiation: A Case Report and Review of Literature

Figure 1. CT of abdomen and pelvis shows bilateral ovarian masses, and short arrow shows left ovarian mass. CT: computed tomography.

Figure 2. CT of abdomen and pelvis shows large bulky nodular mass in the omental carcinomatosis. CT: computed tomography.

Figure 3. High-grade serous carcinoma with papillary and glandular architecture (long arrow) with adjacent choriocarcinomatous differentiation (short arrow), × 4.

Figure 5. Choriocarcinomatous differentiation comprising an admixture of mononucleate cytotrophoblastic cells (short arrow) and multinucleate syncytiotrophoblast-like cells (long arrow), × 10.

Figure 7. Transition zone (arrow) showing intermingling of epithelial and choriocarcinomatous components, × 10.

Figure 8. P53 IHC in both choriocarcinoma and serous carcinoma shows diffuse and strong nuclear positivity, × 4. IHC: immunohistochemistry.

**Table 1.** Summary of IHC Findings in All Cases
Authors	IHC expression in choriocarcinomatous component	IHC expression in epithelial component
SCT: syncytiotrophoblast; CYT: cytotrophoblast; HPL: human placental lactogen; PLAP: placental alkaline phosphatase; AFP: alpha-fetoprotein; CEA: carcinoembryonic antigen; Chr: chromogranin; Syn: synaptophysin; EMA: epithelial membrane antigen; PDL-1: programmed death ligand-1; IHC: immunohistochemistry; β-hCG: beta-human chorionic gonadotrophin; N/A: not applicable.
Oliva et al [3]	Case 1: β-hCG positive in multinucleated cells; case 2: β-hCG in SCT cells	N/A
Ozaki et al [5]	N/A	N/A
Jimenez-Heffernan et al [4]	β-hCG in SCT	N/A
Hirabayashi et al [6]	α-hCG and β-hCG positive in SCT	CEA, CA-125, CA19-9 positive in endometrioid adenocarcinoma; Chr focal positive, Syn positive in small cell carcinoma; CA-125 positive in clear cell carcinoma
Oladipo et al [7]	β-hCG positive; PLAP focal positive; MNF-116 (CK) positive	N/A
Hafezi-Bakhtiari et al [8]	α inhibin positive; HPL positive in SCT; β-hCG positive in both CYT and SCT	EMA positive; AE1/AE3 positive; P53 positive; WT1 negative
Hu et al [9]	HCG positive in SCT; CYT focal positive; HPL positive in CYT	CK7 positive; CD117 negative; CD30 negative; PLAP negative; AFP negative; glypican 3 negative
Shanmugasundaram et al [10]	β-hCG negative
Koyanagi et al [11]	β-hCG positive; AFP negative	CK7 negative; CK20 positive; CDX2 positive; ER negative; CD30 negative; PLAP negative; β-hCG negative
Xing et al [2]	β-hCG positive; PD-L1 positive	β-hCG negative; PD-L1 negative
Present case	GATA-3, PLAP, CK positive; focal p63 positive; WT1, PAX-8, ER, napsin A, AFP and CD30 negative; β-hCG: negative	P53, WT1 and PAX-8 positive in serous component

Table 1. Summary of IHC Findings in All Cases

Authors

IHC expression in choriocarcinomatous component

IHC expression in epithelial component

SCT: syncytiotrophoblast; CYT: cytotrophoblast; HPL: human placental lactogen; PLAP: placental alkaline phosphatase; AFP: alpha-fetoprotein; CEA: carcinoembryonic antigen; Chr: chromogranin; Syn: synaptophysin; EMA: epithelial membrane antigen; PDL-1: programmed death ligand-1; IHC: immunohistochemistry; β-hCG: beta-human chorionic gonadotrophin; N/A: not applicable.

Oliva et al [3]

Case 1: β-hCG positive in multinucleated cells; case 2: β-hCG in SCT cells

N/A

Ozaki et al [5]

N/A

Jimenez-Heffernan et al [4]

β-hCG in SCT

N/A

Hirabayashi et al [6]

α-hCG and β-hCG positive in SCT

CEA, CA-125, CA19-9 positive in endometrioid adenocarcinoma; Chr focal positive, Syn positive in small cell carcinoma; CA-125 positive in clear cell carcinoma

Oladipo et al [7]

β-hCG positive; PLAP focal positive; MNF-116 (CK) positive

N/A

Hafezi-Bakhtiari et al [8]

α inhibin positive; HPL positive in SCT; β-hCG positive in both CYT and SCT

EMA positive; AE1/AE3 positive; P53 positive; WT1 negative

Hu et al [9]

HCG positive in SCT; CYT focal positive; HPL positive in CYT

CK7 positive; CD117 negative; CD30 negative; PLAP negative; AFP negative; glypican 3 negative

Shanmugasundaram et al [10]

β-hCG negative

Koyanagi et al [11]

β-hCG positive; AFP negative

CK7 negative; CK20 positive; CDX2 positive; ER negative; CD30 negative; PLAP negative; β-hCG negative

Xing et al [2]

β-hCG positive; PD-L1 positive

β-hCG negative; PD-L1 negative

Present case

GATA-3, PLAP, CK positive; focal p63 positive; WT1, PAX-8, ER, napsin A, AFP and CD30 negative; β-hCG: negative

P53, WT1 and PAX-8 positive in serous component

**Table 2.** Summary of Clinico-Pathologic Features
Author	Year	Cases	Age	Size (cm)	TZ	Histological type of associated ovarian cancer	Metastatic sites	Prognosis (follow-up)
R: right; L: left; mets: metastases; FU: follow-up; TZ: transition zone; Y: yes; N: no.
Oliva et al [3]	1993	2	59	25	N	Case 1: undifferentiated	Lung, brain	Death in 15 months
			33	30	Y	Case 2: mucinous cystadenoma	Liver, peritoneum	Death in 7 months
Ozaki et al [5]	2001	1	54	12.4		Mucinous cystadenoma	Myometrium, liver, lung	Death in 6 days
Jimenez-Heffernan et al [4]	2002	1	63	17	Y	Mucinous cystadenocarcinoma	None	No recurrence after 7 months of FU
Hirabayashi et al [6]	2006	1	50	12.8	Y	Endometrioid and small cell, focal clear cell component	Peritoneum, liver, lung	Death in 10 months
Oladipo et al [7]	2007	1	60	16		High-grade mixed (Adeno and squamous) Carcinoma	Lung, brain	Died of brain mets, over a year
Hafezi-Bakhtiari et al [8]	2010	1	65	5		High-grade papillary serous carcinoma	Lung	Lung mets after 9 months of FU
Hu et al [9]	2010	1	48	R = 6 cm, L = 5 cm	N	Clear cell carcinoma	Lung, liver, abdominopelvic	Death after 11 months
Shanmugasundaram et al [10]	2015	1	64	R = 4 cm, L = 4 cm		High-grade papillary serous carcinoma	Peritoneum	Stable after 1-year FU
Koyanagi et al [11]	2016	1	29	20	N	Adenocarcinoma (mucinous carcinoma)	Lung	NA
Xing et al [2]	2019	1	44	11.5		Mixed clear cell and endometrioid carcinoma	Lung	Alive with multiple lung mets after 8 months
Present case	2019	1	53	9.4		High-grade serous carcinoma	Liver	Death in 2 months

Table 2. Summary of Clinico-Pathologic Features

Author

Year

Cases

Age

Size (cm)

Histological type of associated ovarian cancer

Metastatic sites

Prognosis (follow-up)

R: right; L: left; mets: metastases; FU: follow-up; TZ: transition zone; Y: yes; N: no.

Oliva et al [3]

1993

Case 1: undifferentiated

Lung, brain

Death in 15 months

Case 2: mucinous cystadenoma

Liver, peritoneum

Death in 7 months

Ozaki et al [5]

2001

12.4

Mucinous cystadenoma

Myometrium, liver, lung

Death in 6 days

Jimenez-Heffernan et al [4]

2002

Mucinous cystadenocarcinoma

None

No recurrence after 7 months of FU

Hirabayashi et al [6]

2006

12.8

Endometrioid and small cell, focal clear cell component

Peritoneum, liver, lung

Death in 10 months

Oladipo et al [7]

2007

High-grade mixed (Adeno and squamous) Carcinoma

Lung, brain

Died of brain mets, over a year

Hafezi-Bakhtiari et al [8]

2010

High-grade papillary serous carcinoma

Lung

Lung mets after 9 months of FU

Hu et al [9]

2010

R = 6 cm, L = 5 cm

Clear cell carcinoma

Lung, liver, abdominopelvic

Death after 11 months

Shanmugasundaram et al [10]

2015

R = 4 cm, L = 4 cm

High-grade papillary serous carcinoma

Peritoneum

Stable after 1-year FU

Koyanagi et al [11]

2016

Adenocarcinoma (mucinous carcinoma)

Lung

Xing et al [2]

2019

11.5

Mixed clear cell and endometrioid carcinoma

Lung

Alive with multiple lung mets after 8 months

Present case

2019

9.4

High-grade serous carcinoma

Liver

Death in 2 months