INCIDENTAL CHORIOCARCINOMA CONFINED TO A NEAR-TERM PLACENTA

A large solitary choriocarcinoma was found incidentally in a placenta from a 36-week gestation following caesarean section performed because of intrauterine fetal distress. Macroscopically, there appeared to be a large old infarct in the centre of the placenta proper. Microscopic ally, there was extensive central necrosis with a rim of viable tropho blastic tumour that had the typical morphology of choriocarcinoma, Alt hough the tumour was floating within maternal blood and was also detec ted in direct contact with fetal vessels, no metastatic disease was re ported in the subsequent 1 1/2 years either in the mother or in the ch ild. Placental infarcts are often not examined histologically, and an intraplacental tumour may thus be missed. Central friability and an un usual colour should alert the pathologist and lead to histological cla rification. The management of an incidentally discovered intraplacenta l choriocarcinoma should be an expectant one, consisting of extensive workup for any evidence of metastases and serial beta-HCG measurements in both mother and child.