Abstract

Choriocarcinoma has been reported in association with endometrial carcinoma and
as a metaplastic change in multiple carcinomas, including liver, urinary
bladder, lung, and the gastrointestinal tract. We report choriocarcinoma in
conjunction with a carcinosarcoma (also called malignant mullerian mixed tumor)
in a 71-year-old woman whose hysterectomy specimen revealed two polypoid lesions
of the endometrium, one arising from the anterior endometrium and one arising
from the posterior endometrium. Histologic examination revealed three histologic
patterns. The anterior endometrial lesion showed a FIGO grade 2 endometrioid
endometrial adenocarcinoma. The posterior endometrial lesion showed a
carcinosarcoma composed of a high-grade adenocarcinoma and scant homologous
stromal sarcoma. In addition, a choriocarcinoma was identified intermixed with
the adenocarcinoma. The syncytiocytotrophoblasts and cytotrophoblasts stained
strongly with [beta] human chorionic gonadotropin ([beta]-hCG) and human
placental lactogen (hPL). The patient's [beta]-hCG levels on postoperative days
14, 27, and 42 were 283, 32, and 7 mIU/mL, respectively. This unusual case
suggests the importance of identifying the choriocarcinomatous component, since
the serum [beta]-hCG can serve as a marker of tumor recurrence postoperatively.