Trophoblastic Neoplasms

  • Kurt Benirschke
  • Peter Kaufmann


Choriocarcinoma is a malignant neoplasm composed exclusively of cytotrophoblast and syncytiotrophoblast. If villi are associated with such invasive tumors, the lesion is referred to as “invasive mole” or chorioadenoma destruens (see Chapter 22). In this discussion, only the truly neoplastic lesions of the gestational trophoblastic diseases (GTDs) are covered. The various classifications of GTDs have been alluded to in the previous chapter, and Soper et al. (1994), who evaluated 454 tumors according to three classifications, found the prognostic aspects to be fairly similar among these otherwise divergent classifications. Perhaps the clinical staging provided the best prognostication. An excellent and concise review of chorionic tumors has summarized recent progress in understanding and therapy of these lesions (Berkowitz & Goldstein, 1996).


Hydatidiform Mole Gestational Trophoblastic Disease Trophoblastic Tumor Gestational Trophoblastic Neoplasia Complete Hydatidiform Mole 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. ACOG: Technical Bulletin No. 178. Management of Gestational Trophoblastic Disease. American College of Obstetricians and Gynecologists, p. 1–7, March, 1993.Google Scholar
  2. Acosta-Sison, H.: Apparent metastatic chorioepithelioma without demonstrable primary chorionic malignancy in the uterus: report of 3 cases; a new possible explanation of its occurrence. Obstet. Gynecol. 10: 165–168, 1957.PubMedGoogle Scholar
  3. Acosta-Sison, H.: The relative frequency of various anatomic sites as the point of first metastasis in 32 cases of chorionepithelioma. Am. J. Obstet. Gynecol. 75: 1149–1152, 1958.PubMedGoogle Scholar
  4. Acosta-Sison, H.: Choriocarcinoma from July 4,1963 to June 30, 1965. Philip. J. Surg. 21: 41–42, 1966.Google Scholar
  5. Amiel, J.-L. and Lebovici, S.: Choriocarcinoma and the HL-A2 antigen (MAC). Rev. Eur. Etud. Clin. Biol. 15: 191–192, 1970.PubMedGoogle Scholar
  6. Arai, K., Soma, H. and Hokano, M.: Ultrastructure of trophoblastic tumor cells. J. Clin. Electron Microsc. 9: 5–6, 1976.Google Scholar
  7. Aranda, J.M. and Martinez, I.: Incidence of choriocarcinoma in Puerto Rico: a 15-year study. Cancer (Phila.) 23: 506–507, 1969.CrossRefGoogle Scholar
  8. Arkwright, P.D., Rademacher, T.W., Dwek, R.A. and Redman, C.W.G.: Pre-eclampsia is associated with an increase in trophoblast glycogen content and glycogen synthase activity, similar to that found in hydatidiform moles. J. Clin. Invest. 91: 2744–2753, 1993.PubMedCrossRefGoogle Scholar
  9. Atkin, N.B.: Sex chromosome studies on trophoblast. In, The Early Conceptus, Normal and Abnormal, pp. 130–134. University Court of the University of St. Andrews, Scotland, 1965.Google Scholar
  10. Axe, S.R., Klein, V.R. and Woodruff, J.D.: Choriocarcinoma of the ovary. Obstet. Gynecol. 66: 111–114, 1985.PubMedGoogle Scholar
  11. Baergen, R.N. and Rutgers, J.L.: Trophoblastic lesions of the placental site. Gen. Diagn. Pathol. 143: 143–158, 1997.PubMedGoogle Scholar
  12. Bagshawe, K.D.: Hydatidiform mole and chorioncarcinoma. Br. Med. J. 1: 1509–1510, 1964.CrossRefGoogle Scholar
  13. Bagshawe, K.D.: Choriocarcinoma. The Clinical Biology of the Trophoblast and Its Tumors. Williams & Wilkins, Baltimore, 1969.Google Scholar
  14. Bagshawe, K.D.: Pulmonary hypertension in gestational chorio- carcinoma: a West London syndrome? Lancet 2: 223, 1988.PubMedCrossRefGoogle Scholar
  15. Bagshawe, K.D. and Noble, M.I.M.: Cardio-respiratory aspects of trophoblastic tumors. Q. J. Med. 35: 39–54, 1966.PubMedGoogle Scholar
  16. Bagshawe, K.D., Golding, P.R. and Orr, A.H.: Choriocarcinoma after hydatidiform mole: studies related to effectiveness of follow-up practice after hydatidiform mole. Br. Med. J. 2: 733–737, 1969.CrossRefGoogle Scholar
  17. Bagshawe, K.D., Rawlins, G., Pike, M.C. and Lawler, S.D.: ABO blood-groups in trophoblastic neoplasia. Lancet 1: 553–557, 1971.PubMedCrossRefGoogle Scholar
  18. Baltazar, J.C.: Epidemiological features of choriocarcinoma. Bull. W.H.O. 54: 523–532, 1976.PubMedGoogle Scholar
  19. Bardawil, W.A. and Toy, B.L.: The natural history of choriocarcinoma: problems of immunity and spontaneous regression. Ann. N.Y. Acad. Sci. 80: 197–261, 1959.PubMedCrossRefGoogle Scholar
  20. Barnes, A.E., Liwnicz, B.H., Schellhaus, H.F., Altshuler, G., Aron, B.S. and Lippert, W.A.: Successful treatment of placental choriocarcinoma metastatic to brain followed by primary brain glioblastoma. Gynecol. Oncol. 13: 108–114, 1982.PubMedCrossRefGoogle Scholar
  21. Beer, A.E. and Billingham, R.E.: The Immunobiology of Mammalian Reproduction. Prentice-Hall, Englewood Cliffs, 1976.Google Scholar
  22. Benjamin, F. and Rorat, E.: Primary gestational choriocarcinoma of the ovary. Am. J. Obstet. Gynecol. 131: 343–345, 1978.PubMedGoogle Scholar
  23. Benson, P.F., Goldsmith, L.L.G. and Rankin, G.L.S.: Massive foetal haemorrhage into maternal circulation as a complication of choriocarcinoma. Br. Med. J. 1: 841–842, 1962.PubMedCrossRefGoogle Scholar
  24. Berkowitz, R.S. and Goldstein, D.P.: Chorionic tumors. N. Engl. J. Med. 335: 1740–1748, 1996.PubMedCrossRefGoogle Scholar
  25. Blackburn, G.K.: Massive fetomaternal hemorrhage due to choriocarcinoma of the uterus. J. Pediatr. 89: 680–681, 1976.PubMedCrossRefGoogle Scholar
  26. van Bogaert, L.-J. and Staquet, J.-P.: Chorionepitheliosis: a rare benign trophoblastic disease. Acta Obstet. Gynecol. Scand. 56: 69–73, 1977.CrossRefGoogle Scholar
  27. Brewer, J.I. and Gerbie, A.B.: Early development of choriocarcinoma. Am. J. Obstet. Gynecol. 94: 692–705, 1966.PubMedGoogle Scholar
  28. Brewer, J.I. and Mazur, M.T.: Gestational choriocarcinoma: its origin in the placenta during seemingly normal pregnancy. Am. J. Surg. Pathol. 5: 267–277, 1981.PubMedCrossRefGoogle Scholar
  29. Brewer, J.I., Rinehart, J.J. and Dunbar, R.W.: Choriocarcinoma. Am. J. Obstet. Gynecol. 81: 574–583, 1961.Google Scholar
  30. Brewer, J.I., Smith, R.T. and Pratt, G.B.: Choriocarcinoma. Absolute 5 year survival rates of 122 patients treated by hysterectomy. Am. J. Obstet. Gynecol. 85: 841–843, 1963.PubMedGoogle Scholar
  31. Brewer, J L, Gerbie, A.B., Dolkart, R.E., Skom, J.H., Nagile, R.G. and Torok, E.E.: Chemotherapy in trophoblastic diseases. Am. J. Obstet. Gynecol. 90: 566–578, 1964.PubMedGoogle Scholar
  32. Brewer, C.A., Adelson, M.D. and Elder, R.C.: Erythrocytosis associated with a placental-site trophoblastic tumor. Obstet. Gynecol. 79: 846–849, 1992.PubMedGoogle Scholar
  33. Buckell, E.W.C. and Owen, T.K.: Chorionepithelioma in mother and infant. J. Obstet. Gynaecol. Br. Emp. 61: 329–330, 1954.PubMedCrossRefGoogle Scholar
  34. Carlson, J.A., Day, T.G., Kuhns, J.G., Howell, R.S. and Masterson, B.J.: Endoarterial pulmonary metastasis of malignant trophoblast associated with a term intrauterine pregnancy. Gynecol. Oncol. 17: 241–248, 1984.PubMedCrossRefGoogle Scholar
  35. Carr, D.H.: Trophoblast growth in the lungs of mice. Obstet. Gynecol. 54: 461–466, 1979.PubMedGoogle Scholar
  36. Carson, S.A., Stovall, T., Umstot, E., Andersen, R., Ling, E. and Buster, J.E.: Rising human chorionic somatomammotropin predicts ectopic pregnancy rupture following methotrexate chemotherapy. Fertil. Steril. 51: 593–597, 1989.PubMedGoogle Scholar
  37. Chandra, S.A., Gilbert, E.F., Viseskul, C., Strother, C.M., Haning, R.V. and Javid, M.J.: Neonatal intracranial choriocarcinoma. Arch. Pathol. Lab. Med. 114: 1079–1082, 1990.PubMedGoogle Scholar
  38. Cheng, H.-M. and Johnson, P.M.: Specificity of trophoblastreactive antibodies in human pregnancy. Arch. Pathol. Lab. Med. 112: 1081, 1988.PubMedGoogle Scholar
  39. Cinader, B., Hayley, M.A., Rider, W.D. and Warwick, O.H.: Immunotherapy of a patient with choriocarcinoma. Can. Med. Assoc. J. 84: 306–309, 1961.PubMedGoogle Scholar
  40. Creinin, M.D., Stewart-Akers, A.M. and DeLoia, J.A.: Methotrexate effects on trophoblast and the corpus luteum in early pregnancy. Am. J. Obstet. Gyneco1. 179: 604–609, 1998.CrossRefGoogle Scholar
  41. Crescimanno, C., Foidart, J.-M., Noel, A., Polette, M., Maquoi, E., Birembaut, P., Baramova, E., Kaufmann, P. and Castel-lucci, M.: Cloning of choriocarcinoma cells shows that invasion correlates with expression and activation of gelatinase A. Exp. Cell Res. 227: 240–251, 1996.PubMedCrossRefGoogle Scholar
  42. Cunanan, R.G., Lippes, J. and Tancinco, P.A.: Choriocarcinoma of the ovary with coexisting normal pregnancy. Obstet. Gynecol. 55: 669–672, 1980.PubMedGoogle Scholar
  43. Daamen, C.B.F. and Bloem, G.W.D.: Chorioepithelioma in mother and child. Ned. Tijdschr. Geneeskd. 105:651–656, 1961; J. Obstet. Gynaecol. Br. Commonw. 68: 144–149, 1961.Google Scholar
  44. Dawood, M.Y.: Serum progesterone and serum human chorionic gonadotropin in gestational and nongestational choriocarcinoma. Am. J. Obstet. Gynecol. 123: 762–765, 1975.PubMedGoogle Scholar
  45. van de Kaa, C.A., Schijf, C.ET., de Wilde, P.C.M., de Leeuw, H., Gemmink, J.H., Robben, J.C.M. and Vooijs, P.G.: Persistent gestational trophoblastic disease: DNA image cytometry andinterphase cytogenetics have limited predictive value. Mod. Pathol. 9: 1007–1014, 1996.PubMedGoogle Scholar
  46. Delfs, E.: Chorionic gonadotrophin determinations in patients with hydatidiform mole and choriocarcinoma. Ann. N.Y. Acad. Sci. 80: 125–142, 1959.PubMedCrossRefGoogle Scholar
  47. Deligdisch, L., Driscoll, S.G. and Goldstein, D.E: Gestational trophoblastic neoplasms: morphologic correlates of therapeutic response. Am. J. Obstet. Gynecol. 130: 801–806, 1978.PubMedGoogle Scholar
  48. Doniach, I., Crookston, J.H. and Cope, T.I.: Attempted treatment of a patient with choriocarcinoma by immunization with her husband’s cells. J. Obstet. Gynaecol. Br. Emp. 65: 553–556, 1958.PubMedCrossRefGoogle Scholar
  49. Dougherty, C.M., Cunningham, C. and Mickal, A.: Choriocarcinoma with metastasis in a postmenopausal woman. Am. J. Obstet. Gynecol. 132: 700–701, 1978.PubMedGoogle Scholar
  50. Driscoll, S.G.: Choriocarcinoma: an “incidental finding” within a term placenta. Obstet. Gynecol. 21: 96–101, 1963.Google Scholar
  51. Driscoll, S.G.: Choriocarcinoma following delivery. Lab. Med. 48: 21A, 1983.Google Scholar
  52. Duleba, A.J., Miller, D., Taylor, G. and Effer, S.: Expectant management of choriocarcinoma limited to placenta. Gynecol. Oncol. 44: 277–280, 1992.PubMedCrossRefGoogle Scholar
  53. Duncan, D.A. and Mazur, M.T.: Trophoblastic tumors: ultra-structural comparison of choriocarcinoma and placental-site trophoblastic tumor. Hum. Pathol. 20: 370–381, 1989.PubMedCrossRefGoogle Scholar
  54. Dyke, P.C. and Fink, L.M.: Latent choriocarcinoma. Cancer (Phila.) 20: 150–154, 1967.CrossRefGoogle Scholar
  55. Eckstein, R.P., Russell, P., Friedlaender, M., Tattersall, M.H.N. and Bradfield, A.: Metastasizing placental site trophoblastic tumor: a case study. Hum. Pathol. 16: 632–636, 1985.PubMedCrossRefGoogle Scholar
  56. Edwards, R.G., Howe, C.W.S. and Johnson, M.H., eds • Immunobiology of Trophoblast. Cambridge University Press, Cambridge,1975.Google Scholar
  57. Ehrman, R.L. and Gliserman, L.E.: Choriocarcinoma: growth patterns in hamster tissues. Nature (Lond.) 202: 404–406, 1964.CrossRefGoogle Scholar
  58. Elston, C.W.: Cellular reaction to choriocarcinoma. J. Pathol. 97: 261–268, 1969.PubMedCrossRefGoogle Scholar
  59. Emery, J.L.: Chorionepithelioma in a new-born male child with hyperplasia of the interstitial cells of the testis. J. Pathol. Bacteriol. 64: 735–739, 1952.PubMedCrossRefGoogle Scholar
  60. Evans, K.T. and Hendrickse, P. de V.: Pulmonary changes in malignant trophoblastic disease. Br. J. Radiol. 38: 161–171, 1965.PubMedCrossRefGoogle Scholar
  61. Ewing, J.: Chorioma. Surg. Gynecol. Obstet. 10:366–392,1910. Ewing, J.R.: Neoplastic Diseases. 4th Ed. Saunders, Philadelphia, 1941.Google Scholar
  62. Fahrner, R.J., McQueeney, A.J., Mosely, J.M. and Petersen, R.W.: Trophoblastic pulmonary thrombosis with cor pulmonale: report of a case due to malignant hydatidiform mole of five years’ duration. J.A.M.A. 170: 1898–1901, 1959.CrossRefGoogle Scholar
  63. Faul, P., Kelehan, P. and Dervan, P.: Interphase cytogenetic study of exaggerated placental site trophoblast using a biotin-labelled peroxidase method (abstract 503). Mod. Pathol. 7: 88A, 1994.Google Scholar
  64. Feldman, K.: Choriocarcinoma with neonatal anemia. N. Engl. J. Med. 296: 880, 1977.PubMedCrossRefGoogle Scholar
  65. Fine, G., Smith, R.W. and Pachter, M.R.: Primary extragenital choriocarcinoma in the male subject: case report and review of the literature. Am. J. Med. 32: 776–794, 1962.PubMedCrossRefGoogle Scholar
  66. Finkler, N.J., Berkowitz, R.S., Driscoll, S.G., Goldstein, D.P. and Bernstein, M.R.: Clinical experience with placental site trophoblastic tumors at the New England Trophoblastic Disease Center. Obstet. Gynecol. 71: 854–857, 1988.PubMedGoogle Scholar
  67. Fischer, H.E., Lichtiger, B. and Cox, I.: Expression of Rh„ (D) antigen in choriocarcinoma of the uterus in an Rh(D)negative patient: report of a case. Hum. Pathol. 16: 1165–1167, 1985.PubMedCrossRefGoogle Scholar
  68. Fox, H. and Laurini, R.N.: Intraplacental choriocarcinoma: report of two cases. J. Clin. Pathol. 41: 1085–1088, 1988.PubMedCrossRefGoogle Scholar
  69. Fukunaga, M. and Ushigome, S.: Malignant trophoblastic tumors: Immunohistochemical and flow cytometric comparison of choriocarcinoma and placental site trophoblastic tumors. Hum. Pathol. 24: 1098–1106, 1993a.PubMedCrossRefGoogle Scholar
  70. Fukunaga, M. and Ushigome, S.: Metastasizing placental site trophoblastic tumor. An immunohistochemical and flow cytometric study of two cases. Am. J. Surg. Pathol. 17: 1003–1010, 1993b.PubMedCrossRefGoogle Scholar
  71. Fukunaga, M., Ushigome, S. and Ishikawa, E.: Choriocarcinoma in situ: a case at an early gestational age. Histopathology 27: 473–476, 1995.PubMedCrossRefGoogle Scholar
  72. Fukunaga, M., Nomura, K. and Ushigome, S.: Choriocarcinoma in situ at a first trimester. Report of two cases indicating an origin of trophoblast of stem villus. Virchows Arch. 429: 185–188, 1996.PubMedGoogle Scholar
  73. Gallmeier, W.M., Bertrams, J., Kuwert, E. and Schmidt, C.G.: Regression des Chorionepithelioms: Zytostatikawirkung und/oder Immunreaktion? Dtsch. Med. Wochenschr. 95: 1810–1815, 1970.CrossRefGoogle Scholar
  74. Galton, M., Goldman, P.B. and Holt, S.F.: Karyotypic and morphologic characterization of a serially transplanted human choriocarcinoma. J. Natl. Cancer Inst. 31: 1019–1035, 1963.PubMedGoogle Scholar
  75. Gill, T.J.: Wegmann, G. and Nisbet-Brown, E.: Immunoregulation and Fetal Survival. Oxford University Press, New York, 1987.Google Scholar
  76. Goldfarb, S., Richart, R.M. and Okagaki, T.: A cytophotometric study of nuclear DNA content of cyto-and syncytiotrophoblast in trophoblastic disease. Cancer (Phila.) 27: 83–92, 1971.CrossRefGoogle Scholar
  77. Goldstein, D.E: The chemotherapy of gestational trophoblastic disease. Principles of clinical management. J.A.M.A. 222: 209–213, 1972.CrossRefGoogle Scholar
  78. Goldstein, D.P. and Berkowitz, R.S., eds.: Trophoblastic Neoplasms. Clinical Principles of Diagnosis and Management. Saunders, Philadelphia, 1982.Google Scholar
  79. Greene, J.B. and McCue, S.A.: Choriocarcinoma with cerebral metastases coexistent with a first pregnancy. Am. J. Obstet. Gynecol. 131: 253–254, 1978.PubMedGoogle Scholar
  80. Grimmer, D., Landas, S. and Kemp, J.D.: IgM antitrophoblast antibodies in a patient with a pregnancy-associated lupuslike disorder, vasculitis, and recurrent intrauterine fetal demise. Arch. Pathol. Lab. Med. 112: 191–193, 1988.PubMedGoogle Scholar
  81. Hackett, E. and Beech, M.: Immunologic treatment of a case of choriocarcinoma. Br. Med. J. 2: 1123–1126, 1961.CrossRefGoogle Scholar
  82. Hammond, C.B., Weed, J.C., Barnard, D.E. and Tyrey, L.: Gestational trophoblastic neoplasia. CA 31: 322–332, 1981.PubMedCrossRefGoogle Scholar
  83. Heifetz, S.A. and Czaja, J.: In situ choriocarcinoma arising in partial hydatidiform mole: implications for the risk of persistent trophoblastic disease. Pediatr. Pathol. 12: 601–611, 1992.PubMedCrossRefGoogle Scholar
  84. Heller, E.L. and Householder, J.M.: Clinicopathologic conference. Am. J. Clin. Pathol. 22: 883–889, 1952.Google Scholar
  85. Hertig, A.T. and Mansell, H.: Tumors of the female sex organs. Part I. Hydatidiform mole and choriocarcinoma. In, Atlas of Tumor Pathology. Sect. IX, Fasc. 33. Armed Forces Institute of Pathology, Washington, D.C., 1956.Google Scholar
  86. Hertz, R.: Quantitative monitoring of chemotherapy of endocrine tumors by hormone assay. J.A.M.A. 222: 1163, 1972.PubMedCrossRefGoogle Scholar
  87. Hertz, R.: Choriocarcinoma and Related Gestational Trophoblastic Tumors in Women. Raven Press, New York, 1978.Google Scholar
  88. Ho, H.-N., Gill, T.J., Klionsky, B., Ouyang, P.-C., Hsieh, C.-Y. and Kunschner, A.: Differences between white and Chinese populations in human leukocyte antigen sharing and gestational trophoblastic tumors. Am. J. Obstet. Gynecol. 161: 942–948, 1989.PubMedGoogle Scholar
  89. Homesley, H.D., Blessing, J.A., Rettenmaier, M., Capizzi, R.L., Major, F.J. and Twiggs, L.B.: Weekly intramuscular methotrexate for nonmetastatic gestational trophoblastic diseases. Obstet. Gynecol. 72: 413–418, 1988.PubMedGoogle Scholar
  90. Hopkins, M., Nunez, C., Murphy, J.R. and Wentz, W.B.: Malignant placental site trophoblastic tumor. Obstet. Gynecol. 66: 955–100S, 1985.Google Scholar
  91. Horn, L.-C. and Bilek, K.: Histologic classification and staging of gestational trophoblastic disease. Gen. Diagn. Pathol. 143: 87–101, 1997.PubMedGoogle Scholar
  92. Horn, L.-C., Bilek, K., Pretzsch, G. and Baier, D.: Chorionkarzinom bei tubarer Extrauteringravidität. Geburtsh. Frauenheilkd. 54: 375–377, 1994.CrossRefGoogle Scholar
  93. Horn, L.-C., Emmrich, P., Bilek, K. and Bruder, E.: Der frühe Trophoblast. II. Tumorförmige Störungen der trophoblastären Entwicklung. Zentralbl. Gynäkol. 118: 591–597, 1996.PubMedGoogle Scholar
  94. Horn, L.-C., Göretzlehner, U. and Dirnhofer, S.: Placental site trophoblastic tumor (PSTT) initially misdiagnosed as cervical carcinoma. Pathol. Res. Pract. 193: 225–230, 1997.PubMedCrossRefGoogle Scholar
  95. Huber, H.: Das Chorionepitheliom. Arch. Gynäkol. 207: 187–201, 1969.PubMedCrossRefGoogle Scholar
  96. Huetter, P.C. and Gersell, D.J.: Placental site nodule: an analysis of 40 cases (abstract 422). Mod. Pathol. 4: 74A, 1993.Google Scholar
  97. Hustin, J. and Jauniaux, E.: Markedly elevated maternal serum alpha-fetoprotein associated with a normal fetus and choriocarcinoma of the placenta. Obstet. Gynecol. 77: 329–330, 1991.PubMedCrossRefGoogle Scholar
  98. Hutchison, J.R., Peterson, E.P. and Zimmermann, E.A.: Coexisting metastatic choriocarcinoma and normal pregnancy: therapy during gestation with maternal remission and fetal survival. Obstet. Gynecol. 31: 331–336, 1968.PubMedCrossRefGoogle Scholar
  99. Iliya, F.A., Williamson, S. and Azar, H.A.: Choriocarcinoma in the Near East. Consanguinity as a possible etiologic factor. Cancer (Phila.) 20: 144–149, 1967.CrossRefGoogle Scholar
  100. Iliya, F.A., Khuri, F.P. and Khuri, S.F.: Multisystem blood group study in trophoblastic disease. Leban. Med. J. 22: 707–711, 1969.Google Scholar
  101. Inferrera, C., Pulle, C., Rigano,A. and Palmara, D.: Aspetti ultra-strutturali e citochimici del coriocarcinoma uterino. Arch. Ostet. Ginecol. 72: 707–744, 1967.Google Scholar
  102. Ivaskova, E., Jakoubkova, J., Zavadil, M., Schneid, V., Koldovsky, P. and Ivanyi, P.: HL-A antigens and choriocarcinoma. Transplant. Proc. 1: 80–81, 1969.PubMedGoogle Scholar
  103. Izhar, M., Siebert, P.D., Oshima, R.G., DeWolf, W.C. and Fukuda, M.N.: Trophoblastic differentiation of human teratocarcinoma cell line HT-H1. Dev. Biol. 116: 510–518, 1986.PubMedCrossRefGoogle Scholar
  104. Jacques, S.M., Qureshi, F., Doss, B.J. and Munkarah, A.: Intraplacental choriocarcinoma associated with viable pregnancy: pathologic features and implications for the mother and infant. Pediatr. Dev. Pathol. 1: 380–387, 1998.PubMedCrossRefGoogle Scholar
  105. Jarrett, D.D. and Pratt-Thomas, H.R.: Metastatic choriocarcinoma appearing as a unilateral renal mass. Arch. Pathol. Lab. Med. 108: 356–357, 1984.PubMedGoogle Scholar
  106. Jauniaux, E., Zucker, M., Meuris, S., Verherst, A., Wilkin, P. and Hustin, J.: Chorangiocarcinoma: an unusual tumour of the placenta; the missing link? Placenta 9: 607–613, 1988.PubMedCrossRefGoogle Scholar
  107. Jones, W.B.: Gestational trophoblastic disease: What have we learned in the past decade ? Am. J. Obstet. Gynecol. 162: 1286–1295, 1990.PubMedGoogle Scholar
  108. Kato, M., Tanaka, K. and Takeuchi, S.: The nature of trophoblastic disease initiated by transplantation into immunosuppressed animals. Am. J. Obstet. Gynecol. 142: 497–505, 1982.PubMedGoogle Scholar
  109. Kirk, J.A.: Persistence of abnormal trophoblast. Am. J. Obstet. Gynecol. 92: 667–669, 1965.PubMedGoogle Scholar
  110. Knoth, M., Hesseldahl, H. and Larsen, J.F.: Ultrastructure of human choriocarcinoma. Acta Obstet. Gynecol. 48: 100–118, 1969a.Google Scholar
  111. Knoth, M., Pattillo, R.A., Garancis, J.C., Gey, G.O., Ruckert, A.C.F. and Mattingly, R.F.: Ultrastructure and hormone synthesis of choriocarcinoma. Am. J. Pathol. 54: 479–488, 1969b.PubMedGoogle Scholar
  112. Kohorn, E.I.: Theca lutein ovarian cyst may be pathognomonic for trophoblastic neoplasia. Obstet. Gynecol. 62: 80S–81S, 1983.PubMedGoogle Scholar
  113. Kolstad, P. and Hognestad, J.: Trophoblastic tumours in Norway. Acta Obstet. Gynecol. Scand. 44: 80–88, 1965.CrossRefGoogle Scholar
  114. Korhonen, J., Alfthan, H., Ylöstalo, P, Veldhuis, J. and Stenman, U.-H.: Disappearance of human chorionic gonadotropin and its a-and [3-subunits after term pregnancy. Clin. Chem. 43: 2155–2163, 1997.PubMedGoogle Scholar
  115. Kruseman, A.C.N., van Lent, M., Blom, A.H. and Lauw, G.P.: Choriocarcinoma in mother and child, identified by immunoenzyme histochemistry. Am. J. Clin. Pathol. 67: 279–283, 1977.PubMedGoogle Scholar
  116. Kurman, R.J., Scully, R.E. and Norris, N.J.: Trophoblastic pseudotumor of the uterus: an exaggerated form of “syncytial endometritis” simulating a malignant tumor. Cancer (Phila.) 38: 1214–1226, 1976.CrossRefGoogle Scholar
  117. Kurman, R.J., Main, C.S. and Chen, H.-C.: Intermediate trophoblast: a distinctive form of trophoblast with specific morphological, biochemical and functional features. Placenta 5: 349–370, 1984.PubMedCrossRefGoogle Scholar
  118. Kushima, K., Noda, K. and Makita, M.: Experimental production of chorionic tumor in rabbits. Tohoku J. Exp. Med. 91: 209–214, 1967.Google Scholar
  119. Lage, J.M. and Roberts, D.J.: Choriocarcinoma in a term placenta: pathologic diagnosis of tumor in an asymptomatic patient with metastatic disease. Int. J. Gynecol. Pathol. 12: 80–85, 1993.PubMedCrossRefGoogle Scholar
  120. Lage, J.M. and Sheikh, S.S.: Genetic aspects of gestational trophoblastic diseases: a general overview with emphasis on new approaches in determining genetic composition. Gen. Diagn. Pathol. 143: 109–115, 1997.PubMedGoogle Scholar
  121. Larsen, J.F., Ehrman, R.L. and Bierring, F: Electron microscopy of human choriocarcinoma transplanted into hamster liver. Am. J. Obstet. Gynecol. 99: 1109–1124, 1967.PubMedGoogle Scholar
  122. Lathrop, J.C., Wachtel, T.J. and Meissner, G.F.: Uterine choriocarcinoma fourteen years following bilateral tubal ligation. Obstet. Gynecol. 51: 477–482, 1978.PubMedCrossRefGoogle Scholar
  123. Lawler, S.D., Klouda, ET. and Bagshawe, K.D.: HL-A system in trophoblastic neoplasia. Lancet 2: 834–837, 1971.PubMedCrossRefGoogle Scholar
  124. Leiserowitz, G.S. and Webb, M.J.: Treatment of placental site trophoblastic tumor with hysterotomy and uterine reconstruction. Obstet. Gynecol. 88: 696–699, 1996.PubMedCrossRefGoogle Scholar
  125. Lewis, J., Gore, H., Hertig, A.T. and Goss, D.A.: Treatment of trophoblastic disease. Am. J. Obstet. Gynecol. 86: 710–722, 1966.Google Scholar
  126. Lewis, J.L., Brown, W.E., Hertz, R., Davis, R.C. and Johnson, R.H.: Heterotransplantation of human choriocarcinoma in monkeys. Cancer Res. 28: 2032–2038, 1968.PubMedGoogle Scholar
  127. Li, M.C.: Chemotherapeutic and immunological aspects of choriocarcinoma. J.A.M.A. 222: 1163–1164, 1972.PubMedCrossRefGoogle Scholar
  128. Li, M.C., Hertz, R. and Spencer, D.B.: Effect of methotrexate therapy upon choriocarcinoma and chorioadenoma. Proc. Soc. Exp. Biol. Med. 93: 361–366, 1956.PubMedGoogle Scholar
  129. Lindsey, J.R., Wharton, L.R., Woodruff, J.D. and Baker, H.J.: Intrauterine choriocarcinoma in a rhesus monkey. Pathol. Vet. 6: 378–384, 1969.PubMedCrossRefGoogle Scholar
  130. Lurain, J.R., Sand, P.K. and Brewer, J.I.: Choriocarcinoma associated with ectopic pregnancy. Obstet. Gynecol. 68: 286–287, 1986.PubMedGoogle Scholar
  131. Madarame, H., Sakurai, H. and Konno, S.: Choriocarcinoma in a DDD mouse: a case report with immunohistochemical and ultrastructural studies. Lab. Anim Sci. 39: 255–258, 1989.PubMedGoogle Scholar
  132. Madden, S.: Chorionepithelioma of the fallopian tube. J. Obstet. Gynaecol. Br. Emp. 57: 68–70, 1950.PubMedCrossRefGoogle Scholar
  133. Makino, S., Sasaki, M.S. and Fukushima, T.: Preliminary notes on the chromosomes of human chorionic lesions. Proc. Jpn. Acad. 39: 54–58, 1963.Google Scholar
  134. Manivel, J.C., Niehans, G., Wick, M.R. and Dehner, L.P.: Intermediate trophoblast in germ cell neoplasms. Am. J. Surg. Pathol. 11: 693–701, 1987.PubMedCrossRefGoogle Scholar
  135. Marchand, F.J.: Über die sogenannten “decidualen” Geschwülste im Anschluss an normale Geburt, Abort, Blasenmole und Extrauterinschwangerschaft. Monatsschr. Geburtshilfe Gynäkol. 1: 419–438, 513–560, 1895.Google Scholar
  136. Marin-Padilla, M. and Benirschke, K.: Thalidomide induced alterations in the blastocyst and placenta of the armadillo, Dasypus novemcinctus mexicanus, including a choriocarcinoma. Am. J. Pathol. 43: 999–1016, 1963.PubMedGoogle Scholar
  137. Marquez-Monter, H. and Velasco, A.F.: Pathologia de los tumores trofoblasticos. Bol. Asoc. Mex. Patol. 5: 11–16, 1967.Google Scholar
  138. Marth, C., Lang, T., Widschwendter, M., Müller-Holzner, E. and Daxenbichler, G.: Effects of taxol on choriocarcinoma cells. Am. J. Obstet. Gynecol. 173: 1835–1842, 1995.PubMedCrossRefGoogle Scholar
  139. Martin, F.I.R. and Carden, A.B.G.: Gynaecomastia in chorionepithelioma—oestrogen levels and probable pathogenesis. Acta Endocrinol. (Copenh.) 43: 203–212, 1963.Google Scholar
  140. Martin, B.R., Orr, J.W. and Austin, J.M.: Cervical choriocarcinoma associated with an intrauterine contraceptive device: a case report. Am. J. Obstet. Gynecol. 147: 343–344, 1983.PubMedGoogle Scholar
  141. Matalon, M., Paz, B., Modan, M. and Modan, B.: Malignant trophoblastic disorders: epidemiologic aspects and relationship to hydatidiform mole. Am. J. Obstet. Gynecol. 112: 101–106, 1972.PubMedGoogle Scholar
  142. Mathé, G., Dausset, J., Hervet, E., Amiel, J.L., Colombani, J. and Brule, G • Immunological studies in patients with placental choriocarcinoma. J. Natl. Cancer Inst. 33: 193–208, 1964.Google Scholar
  143. Mercer, R.D., Lammert, A.C., Anderson, R. and Hazard, J.B.: Choriocarcinoma in mother and infant. J.A.M.A. 166: 482–483, 1958.CrossRefGoogle Scholar
  144. Midgley, A.R. and Jaffe, R.B.: Regulation of human gonadotropins: II. Disappearance of human chorionic gonadotropin following delivery. J. Clin. Endocrinol. 28: 1712–1718, 1968.CrossRefGoogle Scholar
  145. Miller, J.M., Surwit, E.A. and Hammond, C.B.: Choriocarcinoma following term pregnancy. Obstet. Gynecol. 53: 207–212, 1979.PubMedGoogle Scholar
  146. Mills, W.: Chorion-carcinoma in the Midlands. Clin. Radiol. 15: 260–262, 1964.PubMedCrossRefGoogle Scholar
  147. Miyamoto, M.: Experimental induction of choriocarcinoma in rats. Gann 62: 55–56, 1971.PubMedGoogle Scholar
  148. Mogensen, B. and Kissmeyer-Nielsen, F.: Histocompatibility antigens on the HL-A locus in generalised gestational choriocarcinoma: a family study. Lancet 1: 721–724, 1968.PubMedCrossRefGoogle Scholar
  149. Mogensen, B. and Kissmeyer-Nielsen, E: Current data on HL-A and ABO typing in gestational choriocarcinoma and invasive mole. Transplant. Proc. 3: 1267–1269, 1971.Google Scholar
  150. Mogensen, B. and Olsen, S.: Gestational choriocarcinoma in Denmark 1940–1969: a reappraisal based on modern histologic criteria. Acta Obstet. Gynecol. Scand. 51: 63–69, 1972.CrossRefGoogle Scholar
  151. Nagelberg, S.B. and Rosen, S.W.: Clinical and laboratory investigation of a virilized woman with placental-site trophoblastic tumor. Obstet. Gynecol. 65: 527–534, 1985.PubMedGoogle Scholar
  152. Nanke, E.: Über primär heterotopes (ektopisches) Chorionepitheliom und Chorionepitheliosis. Geburtsh. Frauenheilkd. 19: 523–531, 1959.Google Scholar
  153. Nepom, G.T.: The effects of variations in human immune-response genes. N. Engl. J. Med. 321: 751–752, 1989.PubMedCrossRefGoogle Scholar
  154. Nickels, J., Risberg, B. and Melander, S.: Trophoblastic pseudo-tumour of the uterus. Acta Pathol. Microbiol. Scand. A 86: 14–16, 1978.Google Scholar
  155. Nisbet, A.D., Brehmer, R.D., Home, C.H.W., Brooker, D., Twiggs, L.B. and Okagaki, T.: Placental protein 5 in gestational trophoblastic disease: localization and circulating levels. Am. J. Obstet. Gynecol. 144: 396–401, 1982.PubMedGoogle Scholar
  156. Ober, W.B.: Gestational choriocarcinoma: immunological aspects, diagnosis and treatment. Excerpta. Med. Int. Congr. Ser. 203: 304–315, 1969.Google Scholar
  157. Ober, W.B. and Fass, R.O.: The early history of choriocarcinoma. J. Hist. Med. Allied Sci. 16: 49–73, 1961.PubMedCrossRefGoogle Scholar
  158. Ober, W.B. and Maier, R.C.: Gestational choriocarcinoma of the fallopian tube. Diagn. Gynecol. Obstet. 3: 213–231, 1981.PubMedGoogle Scholar
  159. Ober, W.B., Edgcomb, J.H. and Price, E.B.: The pathology of choriocarcinoma. Ann. N.Y. Acad. Sci. 172: 299–426, 1971.PubMedCrossRefGoogle Scholar
  160. Oettle, A.G.: Malignant neoplasms of the uterus in the white, “coloured,” Indian and Bantu races of the Union of South Africa. Acta Unio. Int. Contra Cancrum 17: 915–933, 1961.Google Scholar
  161. Ollendorff, D.A., Goldberg, J.M., Abu-Jawdeh, G.M. and Lurain, J.R.: Markedly elevated maternal serum alphafetoprotein associated with a normal fetus and choriocarcinoma of the placenta. Obstet. Gynecol. 76: 494–497, 1990.PubMedGoogle Scholar
  162. Olive, D.L., Lurain, J.R. and Brewer, J.I.: Choriocarcinoma associated with term gestation. Am. J. Obstet. Gynecol. 148: 711–716, 1984.PubMedGoogle Scholar
  163. Ory, S.J., Villanueva, A.L., Sand, P.K. and Tamura, R.K.: Conservative treatment of ectopic pregnancy with methotrexate. Am. J. Obstet. Gynecol. 154: 1299–1306, 1986.PubMedGoogle Scholar
  164. Parazzini, F., La Vecchia, C., Mangili, G., Caminiti, C., Negri, E., Cecchetti, G. and Fasoli, M.: Dietary factors and risk of trophoblastic disease. Am. J. Obstet. Gynecol. 158:93–100, 1988a. Parazzini, F., Mangili, G., Belloni, C., La Vecchia, C., Liati, P. and Marabini, R.: The problem of identification of prognostic factors for persistent trophoblastic disease. Gynecol. Oncol. 30: 57–62, 1988b.Google Scholar
  165. Park, W.W.: The occurrence of sex chromatin in chorionepitheliomas and hydatidiform moles. J. Pathol. Bacteriol. 74: 197–206, 1957.CrossRefGoogle Scholar
  166. Park, W.W.: Choriocarcinoma: A Study of Its Pathology. Davis, Philadelphia, 1971.Google Scholar
  167. Patterson, W.B.: Normal pregnancy after recovery from metastatic choriocarcinoma. Am. J. Obstet. Gynecol. 72: 183–187, 1956.PubMedGoogle Scholar
  168. Pearl, M.L. and Braga, C.A.: Percutaneous transcatheter embolization for control of life-threatening pelvic hemorrhage from gestational trophoblastic disease. Obstet. Gynecol. 80: 571–574, 1992.PubMedGoogle Scholar
  169. Pierce, G.B. and Midgley, A.R.: The origin and function of human syncytiotrophoblastic giant cells. Am. J. Pathol. 43: 153–173, 1963.PubMedGoogle Scholar
  170. Pushchak, M.J. and Farhi, D.C.: Primary choriocarcinoma of the lung. Arch. Pathol. Lab. Med. 111: 477–479, 1987.PubMedGoogle Scholar
  171. Rahman, M.S., Al-Suleiman, S.A., Rahman, J. and Al-Sibai, M.H.: Advanced abdominal pregnancy—observations in 10 cases. Obstet. Gynecol. 59: 366–372, 1982.PubMedGoogle Scholar
  172. Rauter, B.: Zum Problem des Chorionepithelioms. Wien. Klin. Wochenschr. 80: 634–636, 1968.PubMedGoogle Scholar
  173. Reddy, D.B. and Rao, N.: Trophoblastic tumors: II. Choriocarcinoma: a review of 50 cases. Indian J. Med. 23: 532–537, 1969.Google Scholar
  174. Rhoton-Vlasak, A., Wagner, J.M., Rutgers, J.L., Baergen, R.N., Young, R.H., Roche, P.C., Plummer, T.B. and Gleich, G.J.: Placental site trophoblastic tumor: human placental lactogen and pregnancy-associated major basic protein as immunohistologic markers. Hum. Pathol. 29: 280–288, 1998.PubMedCrossRefGoogle Scholar
  175. Riggs, J.A., Wainer, A.S., Hahn, G.A. and Farell, D.M.: Extrauterine tubal choriocarcinoma. Am. J. Obstet. Gynecol. 88: 637–641, 1964.PubMedGoogle Scholar
  176. Roberts, J.P. and Lurain, J.R.: Treatment of low-risk metastatic gestational trophoblastic tumors with single-agent chemotherapy. Am. J. Obstet. Gynecol. 174: 1917–1924, 1996.PubMedCrossRefGoogle Scholar
  177. Robinson, E., Shulman, J., Ben-Hur, N., Zuckerman, H. and Neuman, Z.: Immunological studies and behaviour of husband and foreign homografts in patients with chorionepithelioma. Lancet 1: 300–302, 1963.PubMedCrossRefGoogle Scholar
  178. Rolon, P.A. and de Lopez, B.H.: Malignant trophoblastic disease in Paraguay. J. Reprod. Med. 23: 94–96, 1979.PubMedGoogle Scholar
  179. Rosenheim, N.B., Wijnen, H. and Woodruff, J.D.: Clinical importance of the diagnosis of trophoblastic pseudotumors. Am. J. Obstet. Gynecol. 136: 635–638, 1980.Google Scholar
  180. Rudolph, R.H. and Thomas, E.D.: HL-A antigens and choriocarcinoma. Lancet 2: 408–409, 1971.PubMedCrossRefGoogle Scholar
  181. Santamaria, M., Benirschke, K., Carpenter, P.M., Baldwin, V.J. and Pritchard, J.A.: Transplacental hemorrhage associated with placental neoplasms. Pediatr. Pathol. 7: 601–615, 1987.PubMedCrossRefGoogle Scholar
  182. Schopper, W. and Pliess, G.: Über Chorionepitheliosis: ein Beitrag zur Genese, Diagnostik and Bedeutung ektopischer chorionepithelialer Wucherungen. Virchows Arch. 317: 347–384, 1949.CrossRefGoogle Scholar
  183. Scott, J.S.: Choriocarcinoma. Am. J. Obstet. Gynecol. 83: 185–193, 1962.PubMedGoogle Scholar
  184. Scott, J.S.: Histocompatibility antigens in choriocarcinoma. Lancet 1: 865–866, 1968.PubMedCrossRefGoogle Scholar
  185. Scully, R.E. and Young, R.H.: Trophoblastic pseudotumor: a reappraisal. Am. J. Surg. Pathol. 5: 75–76, 1981.PubMedCrossRefGoogle Scholar
  186. Searle, F., Leake, B.A., Bagshawe, K.D. and Dent, J.: Serum-SP,pregnancy-specific-ß-glycoprotein in choriocarcinoma and other neoplastic disease. Lancet 1: 579–581, 1978.PubMedCrossRefGoogle Scholar
  187. Seckl, M.J. and Newlands, E.S.: Treatment of gestational trophoblastic disease. Gen. Diagn. Pathol. 143: 159–171, 1997.PubMedGoogle Scholar
  188. Seckl, M.J., Rustin, G.J.S., Newlands, E.S., Gwyther, S.J. and Bomanji, J.: Pulmonary embolism, pulmonary hypertension, and choriocarcinoma. Lancet 338: 1313–1315, 1991.PubMedCrossRefGoogle Scholar
  189. Sheppard, D.M., Fisher, R.A. and Lawler, S.D.: Karyotypic analysis and chromosome polymorphisms in four choriocarcinoma cell lines. Cancer Genet. Cytogenet. 16: 251–258, 1985.CrossRefGoogle Scholar
  190. Shih, I.-M. and Kurman, R.J.: Epithelioid trophoblastic tumor. A neoplasm distinct from choriocarcinoma and placental site trophoblastic tumor simulating carcinoma. Am. J. Surg. Pathol. 22: 1393–1403, 1998.PubMedCrossRefGoogle Scholar
  191. Shintani, S., Glass, L.E. and Page, E.W.: Studies of induced malignant tumors of placental and uterine origin in the rat. I. Survival of placental tissue following fetectomy. II. Induced tumors and their pathogenesis with special reference to choriocarcinoma. III. Identification of experimentally induced choriocarcinoma by detection of placental hormone. Am. J. Obstet. Gynecol. 95:542–549, 550–558, 559–563, 1966.Google Scholar
  192. Silverberg, S.G. and Kurman, R.J.: Tumors of the uterine corpus and gestational trophoblastic disease. Atlas of Tumor Pathology. Third Series, Fasc. 3. Armed Forces Institute of Pathology, Washington, D.C., 1992.Google Scholar
  193. Sohn, N., Chen, S. and Kalra, J.: Nonmetastatic trophoblastic neoplasia of the cervix following termination of a cervical pregnancy. Obstet. Gynecol. 88: 733, 1996.PubMedCrossRefGoogle Scholar
  194. Soma, H., Kiyokawa, T., Akaeda, T., Miyashita, T. and Matayoshi, K.: The chromosomes of a human choriocarcinoma cell line in vitro with special reference to the presence of Y chromosome. Acta Obstet. Gynaecol. Jpn. 20: 239–242, 1973.Google Scholar
  195. Soma, H., Takayama, M., Tokoro, K., Kikuchi, T., Kikuchi, K. and Saegusa, H.: Radioimmunoassay of hCG as an early diagnosis of cerebral metastases in choriocarcinoma patients. Acta Obstet. Gynecol. Scand. 59: 445–448, 1980.CrossRefGoogle Scholar
  196. Soper, J.T., Mutch, D.G., Chin, N., Clarke-Pearson, D.L. and Hammond, C.B.: Renal metastases of gestational trophoblastic disease: a report of eight cases. Obstet. Gynecol. 72: 796–798, 1988.PubMedGoogle Scholar
  197. Soper, J.T., Evans, A.C., Conaway, M.R., Clarke-Pearson, D.L., Berchuck, A. and Hammond, C.B.: Evaluation of prognostic factors and staging in gestational trophoblastic tumor. Obstet. Gynecol. 84: 969–973, 1994.PubMedGoogle Scholar
  198. Spiegel, J.A.: Endoarterial choriocarcinoma of the lung: report of a case and review of the literature. Obstet. Gynecol. 24: 740–748, 1964.PubMedGoogle Scholar
  199. Srivannaboon, S.: Antigenicity of human choriocarcinoma. Int. J. Fertil. 16: 36–41, 1971.PubMedGoogle Scholar
  200. St. Clair, J.T., Wheeler, D.A. and Fish, S.A.: Methotrexate in abdominal pregnancy J.A.M.A. 208: 529–531, 1969.Google Scholar
  201. Stein-Werblowsky, T.: Induction of a chorion-epitheliomatous tumour in the rat. Nature (Lond.) 186: 980, 1960.CrossRefGoogle Scholar
  202. Sullivan, L.G.: Primary choriocarcinoma of the lung in a man. Arch. Pathol. Lab. Med. 113: 82–83, 1989.PubMedGoogle Scholar
  203. Surwit, E.A., Alberts, D.S., Christian, C.D. and Graham, V.E.: Poor-prognosis gestational trophoblastic disease: an update. Obstet. Gynecol. 64: 21–26, 1984.PubMedCrossRefGoogle Scholar
  204. Suzuki, T., Goto, S., Nawa, A., Kurauchi, O., Saito, M. and Tomoda, Y.: Identification of the pregnancy responsible for gestational trophoblastic disease by DNA analysis. Obstet. Gynecol. 82: 629–634, 1993.PubMedGoogle Scholar
  205. Szulman, A.E. and Buchsbaum, H.J., eds.: Gestational Trophoblastic Disease. Springer-Verlag, New York, 1987.Google Scholar
  206. Tanimura, A., Natsuyama, H., Kawano, M., Tanimura, Y., Tanaka, T. and Kitazono, M.: Primary choriocarcinoma of the lung. Hum. Pathol. 16: 1281–1284, 1985.PubMedCrossRefGoogle Scholar
  207. Teacher, J.H.: On chorionepithelioma and the occurrence of chorionepitheliomatous and hydatidiform mole-like structures in teratomata: a pathological and clinical study. J. Obstet. Gynaecol. Br. Emp. 4:1–64, 145–199, 1903.Google Scholar
  208. Thiersch, J.B.: Therapeutic abortions with a folic acid antagonist, 4-aminopteroylglutamic acid (4-amino P.G.A.) administered by the oral route. Am. J. Obstet. Gynecol. 63: 1298–1304, 1952.PubMedGoogle Scholar
  209. Tomoda, Y., Fuma, M., Saiki, N., Ishizuka, N. and Akaza, T.: Immunologic studies in patients with trophoblastic neoplasia. Am. J. Obstet. Gynecol. 126: 661–667, 1976.PubMedGoogle Scholar
  210. Tomoda, Y., Kaseki, S., Goto, S., Nishi, H., Hara, T. and Naruki, M.: Rh-D factor in trophoblastic tumors: a possible cause of the high incidence in Asia. Am. J. Obstet. Gynecol. 139: 742–743, 1981.PubMedGoogle Scholar
  211. Tow, S.H.: Choriocarcinoma: a review of current concepts based on the Singapore experience. Singapore Med. J. 6: 117–126, 1965.Google Scholar
  212. Trask, C., Lage, J.M. and Roberts, D.J.: A second case of “chorangiocarcinoma” presenting in a term asymptomatic twin pregnancy: choriocarcinoma in situ with associated villous vascular proliferation. Intern. J. Gynecol. Pathol. 13: 87–91, 1994.CrossRefGoogle Scholar
  213. Tsang, W.Y.W., Chum, N.P.Y., Tang, S.K., Tse, C.C.H. and Chan, J.K.C.: Mallory’s bodies in placental site nodule. Arch. Pathol. Lab. Med. 117: 547–550, 1993.PubMedGoogle Scholar
  214. Turner, H.B., Douglas, W.M. and Gladding, T.C.: Choriocarcinoma of the ovary. Obstet. Gynecol. 24: 918–920, 1964.PubMedGoogle Scholar
  215. van Thiel, D.H., Ross, G.T. and Lipsett, M.B.: Pregnancies after chemotherapy of trophoblastic neoplasms. Science 169: 1326–1327, 1970.PubMedCrossRefGoogle Scholar
  216. Vaughn, T.C., Surwit, E.A. and Hammond, C.B.: Late recurrences of gestational trophoblastic neoplasia. Am. J. Obstet. Gynecol. 138: 73–76, 1980.PubMedGoogle Scholar
  217. Veinot, J.P., Ford, S.E. and Price, R.G.: Subacute cor pulmonale due to tumor embolization. Arch. Pathol. Lab. Med. 116: 131–134, 1992.PubMedGoogle Scholar
  218. Wake, N., Tanaka, K., Chapman, V., Matsui, S. and Sandberg, A.A.: Chromosomes and cellular origin of choriocarcinoma. Cancer Res. 41: 3137–3143, 1981.PubMedGoogle Scholar
  219. Walden, P.A.M. and Bagshawe, K.D.: Reproductive performance of women successfully treated for gestational trophoblastic tumors. Am. J. Obstet. Gynecol. 125: 1108–1114, 1976.PubMedGoogle Scholar
  220. Weed, J.C. and Hammond, C.B.: Cerebral metastatic choriocarcinoma; intensive therapy and prognosis. Obstet. Gynecol. 55: 89–94, 1980.PubMedGoogle Scholar
  221. Wegmann, T.G. and Gill, T.J.: Immunology of Reproduction. Oxford University Press, New York, 1983.Google Scholar
  222. Wehmann, R.E., Ayala, A.R., Birken, S., Canfield, R.E. and Nisula, B.C.: Improved monitoring of gestational trophoblastic neoplasia using a highly sensitive assay for urinary human chorionic gonadotropin. Am. J. Obstet. Gyneco1. 140: 753–757, 1981.Google Scholar
  223. Wei, P.Y. and Cuyang, P.C.: Trophoblastic disease in Taiwan: a review of 157 cases in a 10 year period. Am. J. Obstet. Gynecol. 85: 844–849, 1963.PubMedGoogle Scholar
  224. Wells, M. and Bulmer, J.N.: The human placental bed: histology, immunohistochemistry and pathology. Histopathology 13: 483–498, 1988.PubMedCrossRefGoogle Scholar
  225. Wenger, M.E., Dines, D.E., Ahmann, D.L. and Good, C.A.: Primary mediastinal choriocarcinoma. Mayo Clin. Proc. 43: 570–575, 1968.Google Scholar
  226. Witzleben, C.L. and Bruninga, G.: Infantile choriocarcinoma: a characteristic syndrome. J. Pediatr. 73: 374–378, 1968.PubMedCrossRefGoogle Scholar
  227. Wolf, H.K. and Michalopoulos, G.K.: Proliferating cell nuclear antigen in human placenta and trophoblastic disease. Pediatr. Pathol. 12: 147–154, 1992.PubMedCrossRefGoogle Scholar
  228. Wynn, R.M. and Davies, J.: Ultrastructure of transplanted choriocarcinoma and its endocrine implications. Am. J. Obstet. Gynecol. 88: 618–633, 1964.PubMedGoogle Scholar
  229. Yamashita, K., Nakamura, T. and Shimizu, T.: Absence of major histocompatibility complex antigens in choriocarcinoma. Am. J. Obstet. Gynecol. 150: 896–897, 1984.PubMedGoogle Scholar
  230. Yazaki, K., Yazaki, C., Wakabayashi, K. and Igarashi, M.: Isoelectric heterogeneity of human chorionic gonadotropin: presence of choriocarcinoma specific components. Am. J. Obstet. Gynecol. 138: 189–194, 1980.PubMedGoogle Scholar
  231. Yen, S. and MacMahon, B.: Epidemiologic features of trophoblastic disease. Am. J. Obstet. Gynecol. 101: 126–132, 1968.PubMedGoogle Scholar
  232. Young, R.H., Kurman, R.J. and Scully, R.E.: Placental site nodules and plaques. A clinicopathologic analysis of 20 cases. Am. J. Surg. Pathol. 14: 1001–1009, 1990.PubMedCrossRefGoogle Scholar
  233. Yuen, B.H., Cannon, W, Benedet, J.L. and Boyes, D.A.: Plasma β-subunit human chorionic gonadotropin assay in molar pregnancy and choriocarcinoma. Am. J. Obstet. Gynecol. 127: 711–712, 1977.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2000

Authors and Affiliations

  • Kurt Benirschke
    • 1
  • Peter Kaufmann
    • 2
  1. 1.University Medical CenterUniversity of California, San DiegoSan DiegoUSA
  2. 2.Institut für Anatomie der Medizinischen FakultätRheinisch-Westfälische Technische Hochschule AachenAachenGermany

Personalised recommendations