20030              SECONDARY CHORIOCARCINOMA

This patient was a woman aged 24.  Her last menstrual period was 9 months before her death and was followed by sporadic loss of brown clots P.V., with some abdominal pain.  Four weeks before admission a miscarriage was diagnosed and a dilatation and curettage was performed.  The pregnancy test was positive.  A further curettage in hospital showed placental remnants in a bicornuate uterus and a diagnosis of choriocarcinoma was made on histological grounds.  She was treated with methotrexate and Actinomycin B.  Although the initial response was gratifying she deteriorated and died five months after the diagnosis was established.  At postmortem there was a large mass of tumour in the pelvis and there were secondaries in the lungs.

The specimen is of the left lung sectioned to show scattered metastatic deposits varying in size up to about 1.5 cms in diameter.  The tumours are rather irregular with areas of cystic degeneration and some small interstitial haemorrhages.  Histology shows a pleomorphic choriocarcinoma with much haemorrhage and necrosis.