Search

Complete hydatidiform moles (CHM) are benign precancerous lesions of the placenta that evolve in 5% of cases into a highly proliferative cancer called choriocarcinoma (CC). Numerous studies have reported correlations between the development of recurrent CHM and mutations in the NLRP7 gene. NLRP7 protein belongs the NLRP7-inflammasome, whose activation contributes to the production of mature IL-1 and IL-18. Most of the work published on NLRP7 was focused on the study of NLRP7 mutations in CHM. Though, no study has characterized its role in normal and tumor placental development. The aim of my thesis project was to characterize the role of this protein in the normal and tumor placenta. Three approaches were used, i) A clinical approach, in collaboration with Casablanca University Hospital; the French reference center of Trophoblastic Gestational Disease and with McGill University. These collaborations allowed for tissue access from MHC and CC patients; ii) An in Vitro / Ex Vivo approach for the characterization of the role of NLRP7 in key processes of normal and tumor placental development using 2D and 3D culture systems. Two trophoblastic cell types were used, a non-tumor cell line, the HTR-8 Sv/Neo and the JEG3 cells, derived from human CC; iii) An In Vivo approach through orthotopic injection of JEG3 cells, invalidated or not for the expression of the NLRP7 gene (ShRNA strategy), in the placenta of gravid mice. The tumor impact of JEG3 following their injection into the uterine horn and the vein of the tail of non-pregnant mice was also examined.The first part of my work showed that NLRP7 protein is abundantly expressed in the normal placenta during the first trimester of pregnancy, that its expression is upregulated by hypoxia, a key parameter in placental development, and that this protein controls key processes of placental development such as proliferation and differentiation. Importantly, I have also demonstrated that NLRP7 plays an important compensatory role in the pathology of intrauterine growth retardation. The second part of my work concerning the role of NLRP7 protein in the placental tumor development demonstrated that i) NLRP7 protein levels are increased in the placenta of MHC and CC patients, and that components of the inflammasome machinery are also deregulated, ii) the JEG3 cells overexpress NLRP7 compared to HTR-8 Sv/Neo, iii) NLRP7 knock-down in JEG3 induced a significant decrease in their proliferation and an increase in their migration and invasion both in the 2D and 3D culture systems. The in vivo study demonstrated that the knock-down of NLRP7 decreased the development and metastasis of human CC in the three tested routes. Immunohistological, RNAseq and antibody-array analyses allowed the characterization of the pathways regulated by the NLRP7 protein in JEG3 cells.Altogether my PhD project characterized the critical role of the NLRP7 protein in normal and tumor placental development and proposes the NLRP7 machinery as a potential target for CC treatment.; Les môles hydatiformes complètes (MHC) sont des lésions bénignes précancéreuses du placenta qui dans 5% des cas évoluent vers un cancer très prolifératif dénommé, choriocarcinome (CC). Différents travaux ont rapporté une corrélation entre le développement des MHC récurrentes et les mutations du gène NLRP7. Ce gène code pour la protéine NLRP7 de l’inflammasome dont l’activation contribue à la production d’IL-1 et IL-18. La majorité des travaux publiés à ce jour se sont intéressés à l’étude des mutations de NLRP7. En revanche, aucune étude n’a caractérisé son rôle dans la placentation normale et tumorale. L’objectif de mon projet de thèse était de caractériser le rôle de cette protéine dans le placenta normal et tumoral. Trois approches ont été utilisées, i) Clinique, en collaboration avec le CHU de Casablanca ; le centre de référence Français des Maladies Gestationnelles Trophoblastiques (MGT) et l’Université Mc Gill pour l’accès aux tissus et sera collectés chez des patientes MHC ou CC; ii) In Vitro/Ex Vivo, pour la caractérisation du rôle du NLRP7 dans les processus clés du développement placentaire normal et tumoral dans des systèmes de cultures en 2D et 3D. Deux lignées trophoblastiques ont été utilisées, les cellules non tumorales HTR-8 Sv/Neo et la lignée JEG3 issue d’un CC humain ; iii) In Vivo, par l’injection orthotopique de cellules JEG3, invalidées ou non pour l’expression du gène NLRP7 (stratégie ShRNA), dans le placenta de souris gestantes. L’impact tumoral des JEG3 suite à leur injection dans la corne utérine et dans la veine de la queue de souris non gestantes a également été étudié.Mes travaux ont démontré que la protéine NLRP7 est abondamment exprimée dans le placenta normal au cours du premier trimestre de la grossesse, que son expression est régulée positivement par l’hypoxie, paramètre clé du développement du placenta et que cette protéine contrôle les processus clés du développement placentaire comme la prolifération et la différentiation trophoblastique. Par ailleurs, j’ai aussi démontré que NLRP7 joue un rôle compensatoire important dans la pathologie du retard de croissance intra-utérin. En relation avec le développement tumoral placentaire, mes travaux ont démontré que, i) la protéine NLRP7 est augmentée dans le placenta de patientes MHC et CC, et que les protéines de la machinerie des inflammasomes sont aussi dérégulées, ii) les cellules tumorales JEG3 surexpriment le NLRP7 comparé au HTR-8 Sv/Neo, iii) l’invalidation de NLRP7 dans les JEG3 induit une baisse de leur prolifération et augmentation de leur migration et invasion dans les systèmes de culture 2D et 3D. L’étude in vivo a démontré que l’invalidation de NLRP7 diminue le développement et la métastase du CC humain dans les trois modèles étudiés. Les analyses immunohistologiques, RNAseq et anticorps-array ont permis la caractérisation des mécanismes régulés par la protéine NLRP7 dans les JEG3. L’ensemble de mes travaux ont mis en évidence le rôle critique de la protéine NLRP7 dans le développement placentaire normal et tumoral et proposent la machinerie NLRP7 comme cible potentielle pour le traitement du CC.

Complete hydatidiform moles (CHM) are benign precancerous lesions of the placenta that evolve in 5% of cases into a highly proliferative cancer called choriocarcinoma (CC). Numerous studies have reported correlations between the development of recurrent CHM and mutations in the NLRP7 gene. NLRP7 protein belongs the NLRP7-inflammasome, whose activation contributes to the production of mature IL-1 and IL-18. Most of the work published on NLRP7 was focused on the study of NLRP7 mutations in CHM. Though, no study has characterized its role in normal and tumor placental development. The aim of my thesis project was to characterize the role of this protein in the normal and tumor placenta. Three approaches were used, i) A clinical approach, in collaboration with Casablanca University Hospital; the French reference center of Trophoblastic Gestational Disease and with McGill University. These collaborations allowed for tissue access from MHC and CC patients; ii) An in Vitro / Ex Vivo approach for the characterization of the role of NLRP7 in key processes of normal and tumor placental development using 2D and 3D culture systems. Two trophoblastic cell types were used, a non-tumor cell line, the HTR-8 Sv/Neo and the JEG3 cells, derived from human CC; iii) An In Vivo approach through orthotopic injection of JEG3 cells, invalidated or not for the expression of the NLRP7 gene (ShRNA strategy), in the placenta of gravid mice. The tumor impact of JEG3 following their injection into the uterine horn and the vein of the tail of non-pregnant mice was also examined.The first part of my work showed that NLRP7 protein is abundantly expressed in the normal placenta during the first trimester of pregnancy, that its expression is upregulated by hypoxia, a key parameter in placental development, and that this protein controls key processes of placental development such as proliferation and differentiation. Importantly, I have also demonstrated that NLRP7 plays an important compensatory role in the pathology of intrauterine growth retardation. The second part of my work concerning the role of NLRP7 protein in the placental tumor development demonstrated that i) NLRP7 protein levels are increased in the placenta of MHC and CC patients, and that components of the inflammasome machinery are also deregulated, ii) the JEG3 cells overexpress NLRP7 compared to HTR-8 Sv/Neo, iii) NLRP7 knock-down in JEG3 induced a significant decrease in their proliferation and an increase in their migration and invasion both in the 2D and 3D culture systems. The in vivo study demonstrated that the knock-down of NLRP7 decreased the development and metastasis of human CC in the three tested routes. Immunohistological, RNAseq and antibody-array analyses allowed the characterization of the pathways regulated by the NLRP7 protein in JEG3 cells.Altogether my PhD project characterized the critical role of the NLRP7 protein in normal and tumor placental development and proposes the NLRP7 machinery as a potential target for CC treatment.; Les môles hydatiformes complètes (MHC) sont des lésions bénignes précancéreuses du placenta qui dans 5% des cas évoluent vers un cancer très prolifératif dénommé, choriocarcinome (CC). Différents travaux ont rapporté une corrélation entre le développement des MHC récurrentes et les mutations du gène NLRP7. Ce gène code pour la protéine NLRP7 de l’inflammasome dont l’activation contribue à la production d’IL-1 et IL-18. La majorité des travaux publiés à ce jour se sont intéressés à l’étude des mutations de NLRP7. En revanche, aucune étude n’a caractérisé son rôle dans la placentation normale et tumorale. L’objectif de mon projet de thèse était de caractériser le rôle de cette protéine dans le placenta normal et tumoral. Trois approches ont été utilisées, i) Clinique, en collaboration avec le CHU de Casablanca ; le centre de référence Français des Maladies Gestationnelles Trophoblastiques (MGT) et l’Université Mc Gill pour l’accès aux tissus et sera collectés chez des patientes MHC ou CC; ii) In Vitro/Ex Vivo, pour la caractérisation du rôle du NLRP7 dans les processus clés du développement placentaire normal et tumoral dans des systèmes de cultures en 2D et 3D. Deux lignées trophoblastiques ont été utilisées, les cellules non tumorales HTR-8 Sv/Neo et la lignée JEG3 issue d’un CC humain ; iii) In Vivo, par l’injection orthotopique de cellules JEG3, invalidées ou non pour l’expression du gène NLRP7 (stratégie ShRNA), dans le placenta de souris gestantes. L’impact tumoral des JEG3 suite à leur injection dans la corne utérine et dans la veine de la queue de souris non gestantes a également été étudié.Mes travaux ont démontré que la protéine NLRP7 est abondamment exprimée dans le placenta normal au cours du premier trimestre de la grossesse, que son expression est régulée positivement par l’hypoxie, paramètre clé du développement du placenta et que cette protéine contrôle les processus clés du développement placentaire comme la prolifération et la différentiation trophoblastique. Par ailleurs, j’ai aussi démontré que NLRP7 joue un rôle compensatoire important dans la pathologie du retard de croissance intra-utérin. En relation avec le développement tumoral placentaire, mes travaux ont démontré que, i) la protéine NLRP7 est augmentée dans le placenta de patientes MHC et CC, et que les protéines de la machinerie des inflammasomes sont aussi dérégulées, ii) les cellules tumorales JEG3 surexpriment le NLRP7 comparé au HTR-8 Sv/Neo, iii) l’invalidation de NLRP7 dans les JEG3 induit une baisse de leur prolifération et augmentation de leur migration et invasion dans les systèmes de culture 2D et 3D. L’étude in vivo a démontré que l’invalidation de NLRP7 diminue le développement et la métastase du CC humain dans les trois modèles étudiés. Les analyses immunohistologiques, RNAseq et anticorps-array ont permis la caractérisation des mécanismes régulés par la protéine NLRP7 dans les JEG3. L’ensemble de mes travaux ont mis en évidence le rôle critique de la protéine NLRP7 dans le développement placentaire normal et tumoral et proposent la machinerie NLRP7 comme cible potentielle pour le traitement du CC.

In 2016, the WHO classification of testicular germ cell tumors was revised considering advances in the understanding of their tumorigenesis and molecular features. This restructuring led to a division into two major groups with, on one hand, prepubertal-type tumors, not derived from germ cell neoplasia in situ (GCNIS), and on the other hand, postpubertal-type tumors, GCNIS-derived, which occur in youg men (seminoma and non seminomatous germ cell tumors - embryonal carcinoma, yolk sac tumor, teratoma and choriocarcinoma essentially). The term germ cell neoplasia in situ is consensually accepted as a new terminology for the precursor lesion. In this new classification, the term "spermatocytic seminoma" is replaced by "spermatocytic tumor", reclassified among non-GCNIS-derived tumors. The purpose of this change of nomenclature is to reflect the usually non-aggressive behaviour of this tumor and to avoid any confusion with usual seminoma. The spectrum of trophoblastic tumors continues to expand with the description of new rare entities such as the cystic trophoblastic tumor, the placental site trophoblastic tumor and the epithelioid trophoblastic tumor. This review aims to provide a focus on testicular germ cell tumors highlighting the new immunohistochemical and molecular features responsible for the restructuring of classification. The TNM staging is presented according to the AJCC 8th edition 2017 update.

Gestational trophoblastic diseases (GTD) correspond to several entities which all have a common pattern: hypersecretion of human chorionic gondotrophin by trophoblastic hyperplasia. Between 2010 and 2012, there were 4 maternal deaths due to GTD (choriocarcinoma). The ratio of maternal death caused by GTD was 0,16/100,000 living births which was similar to the rate from the 2007-2009 period. These deaths represented 1.6% from the whole maternal mortality and 3.3% of the direct maternal mortality. These four deaths occurred after delivery and the diagnosis of GTD was made between 60 and 180 days in the postpartum period. Two cases seemed to be potentially avoidable. The main causes of suboptimal management were linked to delay either in diagnosis of GTD or in initiating the appropriate treatment. The analysis of these maternal deaths gave the opportunity to stress some major lessons to optimize medical management of GTD. Therefore, a patient presenting with persistent bleedings more than six weeks after delivery needs some specific exams such as plasma human chorionic gondotrophin measurement and histopathologic examination to affirm GTD and start early specific treatments generally leading to complete recovery.

We report the case of a 43-year-old woman, who was admitted for intense pelvic pains. Biological investigations showed an increase of β-HCG level. The abdomino-pelvic computed tomography revealed a voluminous mass infiltrating the bladder. A transurethral resection was performed. The histopathological examination evidenced an invasion of the bladder by a massive carcinomatous proliferation composed of clear epithelial cells with in some places syncytiotrophoblastic cells and rarely cytotrophoblastic cells. Immunohistochemical analyses revealed a staining of GATA-3 by the two components, an expression of p63 by the clear cell urothelial component and the immunoreactivity of β-HCG by the trophoblastic component. Ki-67 labeling index was very high. The diagnosis of mixt urothelial carcinoma with clear cells and trophoblastic differentiation was proposed. This is a rare difficult histopathological diagnosis which should be known by pathologists. It is correlated to a poor clinical outcome with a high tendency to lymph node or visceral metastases.

Choriocarcinoma is a rare but agressive malignant trophoblastic neoplasm. Fetomaternal transfusion can be the first sign of choriocarcinoma. We describe two cases of gestational choriocarinoma whose first manifestation was a fetomaternal transfusion. Fetomaternal transfusion is a rare demonstration of choriocarcinoma but its diagnosis must lead to a placenta examination with specific research of choriocarcinoma. The more the therapeutic care is precise, the better is the forecast.

"Growing teratoma syndrome" is a rare and often unrecognized complication of nonseminomatous germ cell tumors of the testis. It is defined by enlarging residual masses, frequently retroperitonal, composed exclusively by teratoma, during the course of chemotherapy. Complications of this syndrome are due to masses compression. Malignant transformation is also possible. "Growing teratoma syndrome" has a good prognosis when cured by complete surgical excision of the tumoral masses. We report the case of a "growing teratoma syndrome" presenting as a retroperitoneal mass occurring in a patient previously treated by orchiectomy and chemotherapy for a nonseminomatous mixed germ cell tumors of the testis without teratomatous component.

Le choriocarcinome est une tumeur trophoblastique hautement maligne. La plupart des cas de choriocarcinome sont intra utérins et d'origine gestationnelle. Le choriocarcinome chez les femmes ménopausées est extrêmement rare. Nous rapportons une observation originale d'une femme ménopausée et nullipare présentant un choriocarciome endometrial non gestationnel survenant 17 ans après sa ménopause. Il n'existe pas de guidelines bien définis pour le traitement des choriocarcinomes en post ménopause. Leur pronostic est très facheux, pourtant il paraît que le stade précoce de la maladie ainsi que les béta hCG plasmatiques négatives seraient à l'origine de ces survies: globale et sans progression relativement longues chez notre patiente (32 mois).

Gestationis pemphigoid is an autoimmune subepidermal blistering dermatosis occurring predominantly in pregnancy, more seldom in early puerperium, and exceptionally in post-abortion. The association of gestationis pemphigoid with choriocarcinoma is extremely rare. We report this association in a patient of 35 years in which the diagnosis of gestationis pemphigoid was made on clinical, histological and immunological criteria, and the one of choriocarcinoma was made on clinical, biological radiological and histological criteria. Through this article, we put the item on this association reported for the first time in post-abortion.

Of all the gestational trophoblastic tumors, the gestational choriocarcinomas have the worst prognosis and the most uncommon. We report a case diagnosed on a full-term placenta, discovered incidentally. The patient, gravida 2, para 1, delivered a hypotrophic infant at 38 weeks gestation. The placenta was examined in the laboratory to perform anatomo-pathological examination in order to explain the growth retardation. This study revealed the presence of an intraplacental choriocarcinoma. Disease staging was negative for both mother and child, and beta-HCG levels remained at zero. These two factors are rather good prognosis for choriocarcinoma. With this observation, we highlight the added-value of placental examination, which seems essential for any fetal pathology, pathological pregnancy and intrapartum complications. Anatomo-pathological examination must be meticulous and systematized in order to not overlook an intraplacental tumor.

Choriocarcinoma is a rare and aggressive tumor that occurs mainly after a molar pregnancy, and exceptionally during a diploid viable pregnancy. We report a case of a 30 years old primipare that revealed a choriocarcinoma at 37 weeks by a generalized seizure. This unusual event did not, however, delay the early introduction of chemotherapy even in the absence of histological diagnosis. This diagnosis must be evoked in woman with genital activity presenting an unknown tumor. Treatment can be started without waiting for the histological evidence, due to the important feature of the hCG assay, significantly improving the prognosis.

The complete hydatidiform mole (CHM), a gestational trophoblastic disease, is usually caused by the development of an androgenic egg whose genome is exclusively paternal. Due to parental imprinting, only trophoblasts develop in the absence of a fetus. CHM are diploid and no abnormal karyotype is observed. It is 46,XX in most cases and less frequently 46,XY. The major complication of this disease is gestational choriocarcinoma, a metastasizing tumor and a true allografted malignancy. This complication is infrequent in developed countries, but is more common in the developing countries and is then worsened by delayed care. The malignancies are often accompanied by acquired, possibly etiological genomic abnormalities. We investigated the presence of recurrent cytogenetic abnormalities in CHM and post-molar choriocarcinoma using metaphasic CGH (mCGH) and high-resolution 244K aCGH techniques. The 10 CHM studied by mCGH showed no chromosomal gains or losses. For post-molar choriocarcinoma, 11 tumors, whose diagnosis was verified by histopathology, were investigated by aCGH. Their androgenic nature and the absence of tumor DNA contamination by maternal DNA were verified by the analysis of microsatellite markers. Three choriocarcinoma cell lines (BeWo, JAR and JEG) were also analyzed by aCGH. The results allowed us to observe some chromosomal rearrangements in primary tumors, and more in the cell lines. Chromosomal abnormalities were confirmed by FISH and functional effect by immunohistochemical analysis of gene expression. Forty minimum critical regions (MCR) were defined on chromosomes. Candidate genes implicated in choriocarcinoma oncogenesis were selected. The presence in the MCR of many miRNA clusters whose expression is modulated by parental imprinting has been observed, for example in 14q32 or in 19q13.4. This suggests that, in gestational choriocarcinoma, the consequences of gene abnormalities directly linked to acquired chromosomal abnormalities are superimposed upon those of imprinted genes altered at fertilization.

Describe the epidemiology, diagnosis and treatment of vesicovaginal fistula (VVF).We conducted a retrospective descriptive study of all cases of VVF secondary to hysterectomy. The following parameters were studied: age, parity, indication for hysterectomy, risk factors, the consultation period, the anatomical type of VVF, the paraclinical, the surgical approach and results of the cure.Fourteen cases were identified over 10 years. All hysterectomies were performed by laparotomia. The average age of patients was 54.3±13 years. Hysterectomy was performed in view of a uterine leiomyoma in eight cases, a cancer of the cervix in four cases, a menometrorrhagia in one case and a choriocarcinoma in one case. Four patients had received neoadjuvant radiotherapy. The mean time from injury was 13.5±18 months. Examination under valve was allowed to find 11 VVF type 1 and three type 2 VVF. IVU was normal in seven patients and allowed to find an ureterohydronephrose stage III in one patient. VVF was addressed by high in ten cases including 5 by transperitoneovaginale and 5 by transvesical pure. The postoperative course was uneventful in 11 patients (78%) but marked by vesicocutaneous fistula, parietal suppuration and one failure.In this short series of post-hysterectomy VVF treated by laparotomia, we observed a rate of cure satisfying in spite of an important psychosocial morbidity.

The choriocarcinoma are neoplasms developed from testicular germ cells in men or fetal trophoblasts in women. The most common sites for metastatis are in the lung, but the endobronchial location is unusual. We report the case of a young patient of 27 years, hospitalized for hemoptysis of moderate volume, occurring in the context of deterioration in his general condition. The radiological assessment revealed an opacity of the right lung and bronchoscopy showed a highly vascularized middle lobe stenosis with biopsy confirming the diagnosis of choriocarcinoma. Urogenital examination found an enlarged left testicle and ultrasound confirmed a tumor-like expansive process with no liver or spleen involvement. HCG levels were high. The patient underwent a left orchiectomy via inguinal, pathological and immunohistochemical study confirmed the diagnosis of testicular choriocarcinoma. The patient received three cycles of chemotherapy based on the BEP with good tolerability. This has allowed chemotherapy, despite endobronchial metastasis, to achieve remission of good quality. The frequency of atypical choriocarcinoma metastases is very low, and treatment is mainly based on chemotherapy.

Chemotherapy is the reference treatment for gestational trophoblastic neoplasia. In case of chemoresistance, hysterectomy has to be considered even in women wishing to conceive. A 31-year-old nulliparous patient presented a recurrent invasive mole, despite two regimens of chemotherapy. She underwent a partial uterine resection of an intramyometrial choriocarcinoma followed by a third-line regimen. Two years later she gave birth by cesarean section at 32 weeks of amenorrhea to a healthy child after a spontaneous pregnancy. In order to preserve patient's fertility, conservative uterine surgery is an alternative to hysterectomy for selected chemoresistant gestational trophoblastic neoplasia.

Gestational trophoblastic diseases comprise of hydatiform mole, invasive mole, choriocarcinoma and placental site trophoblastic tumor. Most of those pathologies are chemosensitive and have excellent prognosis, allowing preserving women's fertility because of the low relapse rate during further pregnancies. Physiopathological mechanisms and risk factors are now better understood. Hydatiform moles have to be treated by suction rather than curettage. Placental site trophoblastic tumors are particular chemoresistant pathologies, not secreting hCG which needs specific management. Trophoblastic tumors can be divided into two groups: a low risk group treated by monotherapy, most often by Methotrexate or actinomycine D, with survey about 100% and a high risk group treated by polychemotherapy (Etoposide, Methotrexate, actinomycine D, cyclophosphamide, Vincristine with survey of 86%. Chemorefractarory patients keep deep prognosis with 5 years survival rate of 43%, which allow development of new therapy in this indication. Measurement of hCG remains today central for supervision. A specialised management by an experimented team is essential to give patients better chance of recovery.

International audience; INTRODUCTION: Choriocarcinoma is a rare tumour which results from the anarchic proliferation of a gonadic or extra gonadic germinal cell. CASE REPORT: A 45 year old pre menopausal woman of African origin presented with a persistent cough and deterioration of general status. The chest X-ray revealed a cavitated mass of the right upper lobe. Other lesions were associated (liver, kidney and scalp). Choriocarcinoma, suspected in the presence of an elevated ssHCG without a gravid uterus, was confirmed by biopsy excision of a haemorrhagic cutaneous lesion of the scalp. Despite the poor prognosis methotrexate based chemotherapy resulted in control of the disease and a good remission.

A male infant was born at 41 weeks' gestation to a 34-year-old primiparous woman after an uneventful pregnancy. Physical examination showed extreme paleness. Fetal hemoglobin was 7.6g/dl and Kleihauher exam revealed fetomaternal hemorrhage. Pathology revealed in situ intraplacental choriocarcinoma. Serum human chorionic gonadotrophin level was undetectable 1 month after the delivery both in woman and in newborn. We suggest that a pathological examination of the placenta should be performed in any case of fetomaternal hemorrhage in order to avoid misdiagnosis of intraplacental choriocarcinoma.

Gastrointestinal adenocarcinoma with a choriocarcinomatous component (GACC) is an extremely rare and highly malignant human chorionic gonadotrophin-producing neoplasm. The development of this tumour from dedifferentiation or trans-differentiation of adenocarcinomatous cells is the most likely mechanism. 102 of the 120 cases reviewed in the literature presented enough clinicopathological information to be analysed. This tumour can be purely choriocarcinomatous or associated with an adenocarcinoma as in half of the observations. It is usually found in the stomach although it may be found throughout the digestive tract. The diagnosis of GACC should only be retained after having clearly eliminated a metastasis from a choriocarcinoma in particular in the gonads. The prognosis is very poor in particular in the gastric forms of this disease, with death observed within 12 months following diagnosis in 2/3 of the patients. There is no treatment consensus, and it is decided on a case-by-case basis.

The authors describe a case report of a tubal choriocarcinoma occurring in women of 32 years old, 2 years after her last pregnancy. The patient was treated by laparoscopic salpingectomy and polychemotherapy. Metastatic pulmonary micronodules were diagnosed at thoraco-abdomino-pelvic tomodensitometry. Patient's recovery was complete with an uneventfull follow-up at 3 years. The association of surgical treatment and chemotherapy used under the guidelines of the FIGO score improves patient's outcome.

Gestational choriocarcinoma is a rare malignant tumour with a strong metastatic potential. We report a case of a 31-year-old patient with a gestational trophoblastic tumor revealed by renal and pulmonary metastases, one year after a normal pregnancy. The diagnosis was established by the pathologist on the radical nephrectomy specimen. The evolution was quickly favorable after adequate treatment using multiagent chemotherapy. This case highlights the polymorphic aspects of the gestational choriocarcinoma and stresses the importance of a betaHCG assessment anytime abnormal symptoms occur in the outcome of a pregnancy.

Uterine choriocarcinoma is a rare trophoblastic tumor, characterized by its metastatic potentiality and its sensitivity to chemotherapy. Pulmonary metastases are frequent, but they rarely reveal the disease. We report the case of a 30-year-old patient with uterine choriocarcinoma. The disease occurred after a normal delivery and was revealed by a pulmonary metastasis. Through of this case and a review of literature, we remind of the diagnostic and prognostic particularities of uterine choriocarcinoma.

To describe the sonographic morphological features of gestational choriocarcinoma.Retrospective evaluation of 13 cases of gestational choriocarcinoma diagnosed by clinical and laboratory (BHCG) criteria in all cases and confirmed by histological data in 8 cases.The tumor presented multiple features (nodular, submucosal, macrocystic, multicystic, compact and microcystic) often with involvement of surrounding tissues. All cases showed myometrial involvement. The size of the ovaries was normal with small corpus luteum cysts noted in only 5 cases. In 2 cases, ultrasound modified the clinical staging.Sonographic features of gestational choriocarcinoma are variable, and may mimic other diseases of the endometrium or myometrium. The involvement of multiple layers of the uterus suggests a malignant disease.

The objective of this study was to define epidemiological profile of choriocarcinoma in Senegal, to evaluate its prognosis and to submit a better strategy of prevention. It's a retrospective cases-control study; all choriocarcinoma diagnosed from January 1st to December 31st 2000 at Dakar University Teaching Hospital. The control were chosen among patients who had molar abortion during the same time than the cases and did not developed the pathology after at least 12 months of medical follow up. The stability of association is checked by calculating 95 confidence interval by Miettinen method, and using Chi 2 test of Pearson with a p value of 5% or Fischer test; the prognosis survival factors was compared using logrank test. Among 1098 patients with medical care follow up of post molar abortion, 61 choriocarcinoma were diagnosed with an incidence of 5.5%. The epidemiological profile is a great multipare 40 years old or more with low socio-economical status, 51% of diagnosed cases was in metastasis stage. The prognosis was marked by a complete remission in 37.7% and by global lethality in 49.2%; the average survival was about 48 months. The risk factors of choriocarcinoma among patients who had a molar abortion are represented by an age superior or equal 40 years old, high multipare and preservation of the uterus after molar abortion. To improve the prognosis we recommend to widen preventive hysterectomy indications after molar abortion among patients with risk factors of choriocarcinoma.

We report a case of a primary uterine choriocarcinoma associated with adenocarcinoma occurring during peri-menopausal age, and review the literature. The clinical course and the histopathology of the case were reviewed and a Medline literature search for other cases was performed. BHCG and analysis of uterine curettage provided the diagnosis of choriocarcinoma. Polychemotherapy, started immediately after the patient's clinical condition deteriorated, was successful. Colpohysterectomy and pelvic lymphadenectomy were performed 5 months later. Treatment was completed by vaginal curietherapy. Histopathologic examination of the surgical specimen revealed only adenocarcinoma. The patient was followed for 18 months without evidence of recurrence. The literature search revealed that primary forms are exceptional; the etiology is unknown. Treatment is based on polychemotherapy. Primary choriocarcinomas are rare tumours, associated with other histopathological forms. We document a case occurring during the peri-menopausal period and review the literature on this pathology. The very poor prognosis in the past has changed with early polychemotherapy.

Choriocarcinoma are germinal tumors from testicular cells in men or foetal trophoblast in women. Cutaneous metastasis are very rare. The authors report a case of angioma-like tumor in a 22-year-old man which was a cutaneous metastasis of a testicular carcinoma. Diagnosis was of course histologic. Testicular echography showed an intra testicular tumor, pulmonary and abdominal CT-scan showed multiple metastases. Orchidectomy and retroperitoneal lymphadenectomy were performed before a general chemotherapy. Patient died 14 months after diagnosis. Only 11 cases of cutaneous metastasis of choriocarcinoma were found in the world literature (7 men and 4 women). All cases showed diagnosis trap for plastic surgeon.

A case of primary choriocarcinoma of the ovary in a 32-year-old woman, 1 month after a voluntary interruption of pregnancy, is reported. A review of the literature shows that this tumour is rare and the distinction between a gestational and a non-gestational choriocarcinoma is difficult. The distinction between these two diagnoses and specific treatment are discussed.