1
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Huang W, Zheng Z, Bao Z, Xiao X, Li L, Sun Z, Kang L. A poor prognostic male choriocarcinoma with multiple systemic metastases: a case report and the literature review. Front Med (Lausanne) 2024; 11:1382672. [PMID: 38572155 PMCID: PMC10989191 DOI: 10.3389/fmed.2024.1382672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
Background Non-gestational choriocarcinoma, also known as primary choriocarcinoma, is extremely rare in men, manifesting with specific signs such as breast feminization, testicular atrophy, and loss of libido. The presentation typically includes elevated serum β-hCG levels, widespread metastatic disease, and a rapid progression of the condition. Case report We present a rare case of a 41-year-old man diagnosed with choriocarcinoma, exhibiting a unique combination of multiple metastases, including lung, brain, bone, and retroperitoneal lymph node metastases, as confirmed by 18F-FDG PET/CT imaging. The patient was treated with aggressive chemotherapy and pembrolizumab, and the prognosis remained poor. The patient's overall survival was a mere 5 months following diagnosis. Conclusion Non-gestational choriocarcinoma represents a rare entity in clinical practice and should be considered in young men presenting with gynaecomastia and elevated β-hCG levels alongside normal gonads. Thus, we advocate for a more comprehensive inquiry into medical history and a systematic examination. The 18F-FDG PET/CT examination not only visually delineates the lesion's location and extent but also serves as a cornerstone for clinical tumor staging, providing valuable support for treatment monitoring and subsequent follow-up.
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Affiliation(s)
- Wenpeng Huang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Zuohuan Zheng
- Department of Traditional Chinese Medicine, The Seventh People’s Hospital of Chongqing, Chongqing, China
| | - Zheng Bao
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Xiaoyan Xiao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Liming Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Zhaonan Sun
- Department of Medical Imaging, Peking University First Hospital, Beijing, China
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
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2
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Rathod SD, Wagh D, Niveditha S. A case of soft-tissue tumor over the sternum: A rare case report. J Cancer Res Ther 2022; 18:S481-S485. [PMID: 36511010 DOI: 10.4103/jcrt.jcrt_649_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The objective is to report a rare case of extragonadal seminoma over the manubrium sterni on the chest wall. A 42-year-old male patient, a chronic alcoholic for 10 years presented with a firm mass of approximate size 10 cm × 12 cm overlying the manubrium part of the sternum. A clinical diagnosis of soft-tissue tumor was made. All relevant preoperative workup was done. Fine-needle aspiration cytology of the mass was suggestive of serous cystic lesion with chronic inflammation. Wide local excision of the mass and primary closure of the wound was done, followed by histopathological examination. Unanticipatedly, on histology, the mass turned out to be extragonadal seminoma. Postoperative wound healing was satisfactory. Subsequently, the patient underwent adjuvant chemotherapy. Primary extragonadal seminoma itself is a rare tumor that affects mainly young people with mediastinum as the most commonly involved site and has higher chances of metastasis. This case of extragonadal seminoma (extragonadal germ cell tumour) over manubrium sterni without any mediastinal involvement in a patient in early forties presenting as soft-tissue tumor, itself is a rarer entity and perhaps one of the kinds. Hence, the case needs to be reported and further progression and prevention have to be discussed.
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Affiliation(s)
- Sagar Dilip Rathod
- Department of General Surgery, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Dhirendra Wagh
- Department of General Surgery, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - S Niveditha
- Department of General Surgery, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
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3
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Zhou Q, Zhou Y, Ouyang Y, Chen W, Zhou X. Hepatoid adenocarcinoma of the stomach with metastatic choriocarcinoma of the liver: A case report of a rare subtype of gastric cancer with a complex treatment course. Front Surg 2022; 9:968891. [PMID: 36157425 PMCID: PMC9500356 DOI: 10.3389/fsurg.2022.968891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/19/2022] [Indexed: 11/26/2022] Open
Abstract
Gastric hepatoid adenocarcinoma and hepatic choriocarcinoma are rare diseases in clinical settings, and the case we report here is a combination of both. A 66-year-old woman presented with a chief complaint of abdominal discomfort. The patient was examined using gastroscopy and computed tomography (CT) scan, and these revealed an irregular surface ulcer on the wall of the gastric antrum. A mass, 2.0 cm in diameter, was found in the liver in April 2020. The endoscopic biopsy findings were consistent with a diagnosis of moderately to poorly differentiated hepatoid adenocarcinoma. She was then referred to our hospital for further treatment. Initially, neoadjuvant therapy was initiated for the patient. The CT scan showed that the liver metastases had progressed; hence, surgery was performed. Postoperative pathology showed that the gastric lesions were mostly hepatoid adenocarcinoma with no choriocarcinoma, while the liver lesions comprised approximately 10% hepatoid adenocarcinoma and 90% choriocarcinoma. One month later, the patient developed tumor recurrence in the liver as observed on CT imaging. Subsequently, a variety of chemotherapy regimens were tried with no obvious results. The patient eventually developed multiple organ metastasis and died in July 2021. The overall survival was 16 months. Based on findings from this case report, it appears that initial neoadjuvant therapy was not effective and radical surgery may be the best treatment for patients with hepatoid adenocarcinoma of the stomach.
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Affiliation(s)
- Qiyang Zhou
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yudi Zhou
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yiming Ouyang
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weichang Chen
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaojun Zhou
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Correspondence: Xiaojun Zhou
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4
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De Jesus O, Pellot Cestero JE, Gómez-González FM, Vélez R. Primary non-gestational mediastinal choriocarcinoma metastatic to the brainstem. BMJ Case Rep 2022; 15:e248389. [PMID: 35365470 PMCID: PMC8977749 DOI: 10.1136/bcr-2021-248389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/03/2022] Open
Abstract
Choriocarcinoma is a highly malignant tumour emerging from the syncytiotrophoblast divided into gestational and non-gestational presentations. Primary choriocarcinoma of the mediastinum is rare. Metastases to the brain often occur; however, brainstem involvement has not been reported for non-gestational choriocarcinoma. We described a middle-aged man who developed a complete left oculomotor nerve paralysis secondary to a brainstem tumour at the midbrain. The workup for the primary source of the brainstem tumour included a chest CT scan, which revealed a mediastinal mass. A mediastinal mass needle biopsy confirmed the diagnosis of primary mediastinal choriocarcinoma. Despite aggressive chemotherapy, the patient died 6 months after the initial presentation from neurological complications and multiorgan failure.
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Affiliation(s)
- Orlando De Jesus
- Neurosurgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Joel E Pellot Cestero
- Neurosurgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Frances M Gómez-González
- Pathology and Laboratory Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Román Vélez
- Pathology and Laboratory Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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5
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Shibata N, Nyuzuki H, Sasaki S, Ogawa Y, Okada M, Nagasaki K. Peripheral precocious puberty in a girl with an intracranial hCG-producing tumor: case report and literature review. Endocr J 2021; 68:1463-1467. [PMID: 34275973 DOI: 10.1507/endocrj.ej21-0117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Human chorionic gonadotropin (hCG)-producing tumors cause peripheral precocious puberty (PP) in boys, but generally not in girls. Homology between LH and hCG activates the LH receptor in testicular Leydig cells, increases testosterone production, and causes virilization. However, since FSH action is required for follicle development, hCG action alone does not increase estradiol (E2) production and does not cause feminization. Only a few cases of peripheral PP with hCG tumors in girls have been reported. We describe the case of a 7-year-old Japanese girl with peripheral PP associated with an hCG-producing tumor. She had prolonged vomiting, loss of appetite, and Tanner stage III breast development. Although no apparent increase in growth rate, bone age was advanced at 9.8 years. Serum E2 was slightly elevated and LH and FSH were below the measurement sensitivity, and abdominal ultrasonography and computed tomography images showed no abnormal findings in the uterus or ovaries. Subsequently, she developed visual field disturbance and loss of consciousness, and brain magnetic resonance imaging revealed an intracranial tumor. Based on pathological findings and abnormally high serum hCG-β level (48,800 IU/L), intracranial choriocarcinoma was diagnosed. 2.5 months after the start of chemotherapy, the hCG-β level became almost negative and the breast development disappeared synchronously. Tissue immunostaining of the tumor showed strong positivity for aromatase and hCG, indicating that the choriocarcinoma cells themselves may have produced estrogen via aromatase. This unique case highlights the possibility that hCG-producing tumors can cause peripheral PP in girls as well as boys.
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Affiliation(s)
- Nao Shibata
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Hiromi Nyuzuki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Sunao Sasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Yohei Ogawa
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
- Division of Community Medicine, Department of Community Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Masayasu Okada
- Department of Neurosurgery, Brain Research Institute, School of Medicine and Graduate School of Medical/Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Keisuke Nagasaki
- Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
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6
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Zhou Y. A Rare Case of Extra-Gonadal Oestrogen-Secreting Choriocarcinoma in a Male. Eur J Case Rep Intern Med 2021; 8:002814. [PMID: 34671579 DOI: 10.12890/2021_002814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/13/2021] [Indexed: 11/05/2022] Open
Abstract
This report describes a rare case of an extra-gonadal oestrogen-secreting tumour in a male patient. An otherwise healthy 60-year-old man presented to our hospital with a 3-month history of shortness of breath and weight loss. Blood panels and histology supported the diagnosis of an oestrogen-secreting choriocarcinoma. Unfortunately, the patient died soon after his diagnosis. The highlighting features of this case are: (1) the difficulty of confirming a diagnosis in a rapidly deteriorating patient; (2) the rarity of oestrogen-secreting extra-gonadal tumours in males; and (3) the aggressive rate of tumour progression seen on sequential imaging. LEARNING POINTS Extra-gonadal oestrogen-secreting tumours in males are rare, but early empiric chemotherapy can be of benefit if this diagnosis is suspected.Tumour progression can be rapid, and so prompt referral to oncology services is critical for emergent management of the condition.Full endocrine blood panels including oestrogen, β human chorionic gonadotrophin and α fetoprotein are useful to help diagnose the condition.
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Affiliation(s)
- Yuxuan Zhou
- Department of General Medicine, Whangarei Hospital, Northland District Health Board, Whangarei, New Zealand
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7
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Mannan R, Sharma S, Goyal S, Bhasin TS. Ectopic Non-gestational Pure Choriocarcinoma of the Urinary Bladder in a Young Nulliparous Female: A Diagnostic Challenge. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_71_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractChoriocarcinoma can occur at ectopic extragenital locations such as lungs, mediastinum, retroperitoneum, and even in the brain (nongestational choriocarcinoma). Choriocarcinoma arising in the urinary bladder is extremely uncommon with only a few cases reported worldwide. It is important to recognize and give comprehensive diagnosis of this entity, as it has poorer prognosis as compared to the conventional gestational choriocarcinoma and requires stepped-up chemotherapy. Here, we present such a case in a 19-year-old girl and the diagnostic conundrum associated with it.
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Affiliation(s)
- Rahul Mannan
- Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab
| | - Sonam Sharma
- Department of Pathology, Kalpana Chawla Government Medical College, Karnal, Haryana
| | - Saloni Goyal
- Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab
| | - Tejinder Singh Bhasin
- Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab
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8
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Zhao W, Chen T, Yang Y. Primary extragenital choriocarcinoma in posterior mediastinum in a male adult: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:703. [PMID: 31930104 DOI: 10.21037/atm.2019.09.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary extragenital choriocarcinoma is a highly malignant tumor and usually occurs in the midline of the body, such as the mediastinum, retroperitoneum, pineal gland and the middle part of the brain. In this report we present a case of primary extragenital choriocarcinoma located in the posterior mediastinum. A 40-year-old man was admitted to hospital with severe chest wall pain for 2 months. Enhanced chest computed tomography (CT) showed a mass of soft tissue measuring 5.2 cm × 4.5 cm located in the posterior mediastinum. CT-guided percutaneous fine needle aspiration (FNA) biopsy was performed and adenocarcinoma was diagnosed. After careful examination, complete tumor resection with combined resection of part left upper lobe of lung and lymph node dissection were performed. Combining hematoxylin/eosin staining and immunohistochemical a pathological diagnosis of choriocarcinoma was made.
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Affiliation(s)
- Weigang Zhao
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200030, China
| | - Tangbing Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yi Yang
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200030, China
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9
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Rehman T, Hameed A, Beharry N, Parcq JD, Bano G. An unusual cause of gynaecomastia in a male. Endocrinol Diabetes Metab Case Rep 2019; 2019. [PMID: 31373476 PMCID: PMC6612059 DOI: 10.1530/edm-19-0060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Summary Beta-human chorionic gonadotropin (βhCG) is normally produced by syncytiotrophoblasts of the placenta during pregnancy and aids embryo implantation. However, it is also secreted in varying amounts in non-pregnant conditions commonly heralding a neoplastic process. We present a case of 50-year-old man, who presented with bilateral gynaecomastia with elevated testosterone, oestradiol, suppressed gonadotropins with progressively increasing levels of human chorionic gonadotropin (hCG). Biochemical and radiological investigations including ultrasonography of testes, breast tissue, MRI pituitary and CT scan full body did not identify the source of hCG. FDG PET scan revealed a large mediastinal mass with lung metastasis. Immunostaining and histological analysis confirmed the diagnosis of primary choriocarcinoma of the mediastinum. It is highly aggressive and malignant tumor with poor prognosis. Early diagnosis and management are essential for the best outcome. Learning Points High βhCG in a male patient or a non-pregnant female suggests a paraneoplastic syndrome.
In the case of persistently positive serum hCG, exclude immunoassay interference by doing the urine hCG as heterophilic antibodies are not present in the urine.
Non-gestational choriocarcinoma is an extremely rare trophoblastic tumor and should be considered in young men presenting with gynaecomastia and high concentration of hCG with normal gonads.
A high index of suspicion and extensive investigations are required to establish an early diagnosis of extra-gonadal choriocarcinoma.
Early diagnosis is crucial to formulate optimal management strategy and to minimize widespread metastasis for best clinical outcome.
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Affiliation(s)
- Tejhmal Rehman
- Departments of Endocrinology Diabetes and Metabolism, St George’s University Hospitals NHS Trust, London, UK
| | - Ali Hameed
- Departments of Endocrinology Diabetes and Metabolism, St George’s University Hospitals NHS Trust, London, UK
| | - Nigel Beharry
- Departments of Radiology, St George’s University Hospitals NHS Trust, London, UK
| | - J Du Parcq
- Departments of Histopathology, St George’s University Hospitals NHS Trust, London, UK
| | - Gul Bano
- Departments of Endocrinology Diabetes and Metabolism, St George’s University Hospitals NHS Trust, London, UK
- Correspondence should be addressed to G Bano;
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10
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Batman S, Morgan T, Brunetti M, Strandabø RAU, Micci F, Moffitt M, Pejovic T. Primary mediastinal choriocarcinoma in a female patient: Case report and review of the literature. Gynecol Oncol Rep 2018; 26:99-101. [PMID: 30456287 PMCID: PMC6232631 DOI: 10.1016/j.gore.2018.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/26/2018] [Accepted: 10/28/2018] [Indexed: 11/15/2022] Open
Abstract
Primary mediastinal choriocarcinoma is rare, especially in female patients. Genomic losses predominated our case, which has not been previously reported. This tumor lacked human chorionic gonadotropin and required histologic diagnosis.
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Affiliation(s)
- Samantha Batman
- Department of Obstetrics and Gynecology, Oregon Health &Science University, Portland, Oregon, USA
| | - Terry Morgan
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Marta Brunetti
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital, Radium Hospital, 0310 Oslo, Norway
| | - Rønnaug A U Strandabø
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital, Radium Hospital, 0310 Oslo, Norway
| | - Francesca Micci
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital, Radium Hospital, 0310 Oslo, Norway
| | - Melissa Moffitt
- Department of Obstetrics and Gynecology, Oregon Health &Science University, Portland, Oregon, USA
| | - Tanja Pejovic
- Department of Obstetrics and Gynecology, Oregon Health &Science University, Portland, Oregon, USA
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11
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Ahn Y, Kim JH, Park CS, Kim TE, Hwang S, Lee SG. Multidisciplinary approach for treatment of primary hepatic choriocarcinoma in adult male patient. Ann Hepatobiliary Pancreat Surg 2018; 22:164-168. [PMID: 29896579 PMCID: PMC5981148 DOI: 10.14701/ahbps.2018.22.2.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/20/2017] [Accepted: 12/30/2017] [Indexed: 11/29/2022] Open
Abstract
Choriocarcinoma is a rare malignant germ cell tumor and it usually occurs in the gonads (ovary or testis) and uterus. Primary hepatic choriocarcinoma (PHC) is a variant of choriocarcinoma featuring sole liver presentation without any evidence of gonodal involvements. Adult male patients with PHC carry dismal prognosis and their median survival period was less than 5 months. We herein present a first Korean case of a 54-year-old male patient with adult PHC, who was treated by surgical resection and chemotherapy through a multidisciplinary approach.
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Affiliation(s)
- Yongchel Ahn
- Department of Hematology-Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Ji-Hoon Kim
- Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Cheon-Soo Park
- Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Tae-Eun Kim
- Department of Pathology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Shin Hwang
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Gyu Lee
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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12
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Li Y, Chen G, Chen H, Wen S, Xiong CY, Yang ZY, Zhu YX, Jeffreys N. Spontaneous renal hemorrhage secondary to choriocarcinoma in a man with congenital hypospadias and cryptorchidism: a case report and literature review. BMC Cancer 2018; 18:543. [PMID: 29739453 PMCID: PMC5941373 DOI: 10.1186/s12885-018-4424-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Choriocarcinoma is a rare malignant germ-cell tumour, most commonly found in adult women. It infrequently presents as spontaneous renal haemorrhage (SRH). Genital malformation and SRH secondary to choriocarcinoma has previously been only reported in females. We present what we believe to be the first case of a male patient with genital malformation (hypospadias and cryptorchidism) and SRH at presentation of choriocarcinoma. Case presentation A 25-year-old man presented to the department with intense pain in the right flank region and lower back. Initial investigations showed spontaneous renal haemorrhage, for which an emergency partial nephrectomy was performed. Clinical, radiological, and pathological investigations suggested a diagnosis of testicular choriocarcinoma with metastases to the right kidney, both lungs, and brain. Initial treatment was with a chemotherapy regimen of cisplatin, etoposide and bleomycin and whole brain radiotherapy; however, 6 months after diagnosis the patient developed liver metastasis, after which time the BEP protocol was switched to ITP with oral apatinib. Despite best efforts, the liver and lung metastasis continued to grow and a decision was made to discontinue active treatment and provide only palliative care until the patient passed away. Conclusion Choriocarcinoma is a difficult cancer to diagnose pre-operatively. In male patients with early metastasis, prognosis may be much poorer than in the commoner gestational choriocarcinoma. A multidisciplinary with comprehensive post-surgical intervention is of great importance in the treatment of these patients.
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Affiliation(s)
- Yi Li
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, 400016, Chongqing, China
| | - Gang Chen
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, 400016, Chongqing, China.
| | - Han Chen
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, 400016, Chongqing, China
| | - Shuang Wen
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, 400016, Chongqing, China
| | - Chao-Yu Xiong
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, 400016, Chongqing, China
| | - Zi-Yi Yang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, 400016, Chongqing, China
| | - Yun-Xiao Zhu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, 400016, Chongqing, China
| | - Nathan Jeffreys
- University College London Medical School, Medical School Building, 74 Huntley Street, London, WC1E 6BT, England, UK
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13
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Meshram RM, Abhisheik S, Hardas V, Siddharth K. Massive Hemoptysis: A Rare Presentation of Anterior Mediastinal Teratoma in an Adolescent. INDIAN JOURNAL OF MEDICAL AND PAEDIATRIC ONCOLOGY : OFFICIAL JOURNAL OF INDIAN SOCIETY OF MEDICAL & PAEDIATRIC ONCOLOGY 2017; 38:215-217. [PMID: 28900334 PMCID: PMC5582563 DOI: 10.4103/ijmpo.ijmpo_62_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Germ cell tumors are predominantly found in the gonads, and the most common extragonadal site is anterior mediastinum. Usual symptoms are cough, dyspnea, and fever, chest pain due to mass effect or intrapulmonary invasion but hemoptysis is rare and may result from either communication with tracheobronchial tree or may result from bronchial bleeding due to irritation by tumor. As in our case, patient presenting with massive hemoptysis and shock are the rarest presentation of a benign teratoma.
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Affiliation(s)
- Rajkumar M Meshram
- Department of Paediatrics, Government Medical College, Nagpur, Maharashtra, India
| | - S Abhisheik
- Department of Paediatrics, Government Medical College, Nagpur, Maharashtra, India
| | - Vaidehi Hardas
- Department of Paediatrics, Government Medical College, Nagpur, Maharashtra, India
| | - K Siddharth
- Department of Paediatrics, Government Medical College, Nagpur, Maharashtra, India
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14
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Zhu R, Jia C, Yan J, Luo Y, Huo Z. Primary pulmonary choriocarcinoma in a male that was successfully diagnosed and treated: A case report and review of the literature. Medicine (Baltimore) 2016; 95:e5693. [PMID: 28033262 PMCID: PMC5207558 DOI: 10.1097/md.0000000000005693] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Primary pulmonary choriocarcinoma (PPC) is extremely rare, especially in males. It is characterized by a poor response to therapy and shortened survival times. Here, we report a successful diagnosis and modified treatment for PPC in a male and a review of the literature. CASE PRESENTATION This case report describes a 67-year-old male who was discovered to have a left pulmonary mass. The patient underwent a pulmonary lobectomy. Pathological examination showed a poorly biphasic differential tumor. Immunostaining displayed that beta-human chorionic gonadotropin (β-HCG), CD10, and GATA3 were positive, and the increase of postoperative serum β-HCG secretion was also confirmed. Systemic and genital screening was performed, but other abnormal findings were not observed. The diagnosis of PPC was confirmed. Then, the patient received 4 cycles of modified chemotherapy according the condition of his body. The patient has been alive for >13 months without recurrence, and the level of serum β-HCG has already decreased to normal. In addition to reporting this case, we have also summarized the similar previously published cases. CONCLUSIONS Currently, there is no standard treatment for PPC. A rapid and correct diagnosis is necessary. Surgery and modified chemotherapy, based on the physical condition of the patient, may currently be the best therapy for PPC.
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Affiliation(s)
- Ran Zhu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing 100730, China
- Department of Pathology, Changping Hospital of Integrated Chinese and Western Medicine, Beijing 102208, China
| | - Congwei Jia
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing 100730, China
| | - Jie Yan
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing 100730, China
| | - Yufeng Luo
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing 100730, China
| | - Zhen Huo
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Wangfujing Street, Dongcheng District, Beijing 100730, China
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15
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Willems E, Martens S, Beelen R. Robotically enhanced mediastinal teratoma resection: a case report and review of the literature. Acta Chir Belg 2016; 116:309-312. [PMID: 27426655 DOI: 10.1080/00015458.2016.1147264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mediastinal teratomata are rare, extragonadal germ cell tumors, which can occur at any age and are often asymptomatic. We present the case of a 57-year-old female with chronic cough diagnosed with a mass in the anterior mediastinum. The mass was successfully resected using the Intuitive Da Vinci® robotic system. The patient had an uneventful recovery. Review of the literature demonstrates that robotic surgery of the mediastinum is a safe and feasible alternative in selected cases.
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Affiliation(s)
- Edward Willems
- Department of Cardiovascular and Thoracic Surgery, OLV, Aalst, Belgium
| | | | - Roel Beelen
- Department of Cardiovascular and Thoracic Surgery, OLV, Aalst, Belgium
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16
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Zhang J, Wang ZJ, Yang B, Wei YY, Yang L, Hu Y, Hu YP. Biochemical remission by chemoradiotherapy in male mediastinal choriocarcinoma with diffuse lung metastasis: A case report. Oncol Lett 2016; 11:2615-2618. [PMID: 27073527 DOI: 10.3892/ol.2016.4248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 01/29/2016] [Indexed: 12/27/2022] Open
Abstract
Primary mediastinal choriocarcinoma is a rare malignancy that is characterized by multiple metastases at the time of diagnosis, poor response to therapy and short survival times. There is no standard treatment for this disease. The present study described the case of a 25-year-old man with metastatic mediastinal choriocarcinoma. The patient completed 8 cycles of standard combination chemotherapy consisting of etoposide [100 mg/m2; intravenous (IV) drip on days 1-3], cisplatin (20 mg/m2; IV drip on days 1-5) and bleomycin (20 mg/m2; intramuscular injection on days 1, 8 and 15 every 21 days). The α-fetoprotein level decreased to 2.36 ng/ml, the serum β-human chorionic gonadotropin (β-HCG) level markedly decreased to 8.69 IU/l, which was slightly higher than the normal upper limit, and the lactate dehydrogenase level decreased to a normal range. The computed tomography (CT) scan revealed that the number and size of the lung lesions was significantly reduced subsequent to 8 cycles of chemotherapy and the size of the mediastinal tumor was evidently reduced, with a less solid component and a more cystic component. The response assessment indicated partial remission. Following chemotherapy, a radiation dose of 50 Gy (2.0 Gy/fraction) was administered to the involved field of the mediastinum. Following radiotherapy, the β-HCG level had also decreased to normal levels, and CT evaluation revealed that the size of the residual lung lesions demonstrated no evident change, and the mediastinal tumor was slightly reduced in size, with a less solid component. The patient refused to undergo surgery and did not receive additional treatment following radiotherapy. At present, the patient has survived >16 months of follow-up without any symptoms.
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Affiliation(s)
- Jing Zhang
- Department of Medical Oncology, Hubei Cancer Hospital, Wuhan, Hubei 430079, P.R. China
| | - Zhi-Jun Wang
- Department of Medical Oncology, Hubei Cancer Hospital, Wuhan, Hubei 430079, P.R. China
| | - Bin Yang
- Department of Medical Oncology, Hubei Cancer Hospital, Wuhan, Hubei 430079, P.R. China
| | - You-Ying Wei
- Department of Medical Oncology, Hubei Cancer Hospital, Wuhan, Hubei 430079, P.R. China
| | - Ling Yang
- Department of Medical Oncology, Hubei Cancer Hospital, Wuhan, Hubei 430079, P.R. China
| | - Yang Hu
- Department of Medical Oncology, Hubei Cancer Hospital, Wuhan, Hubei 430079, P.R. China
| | - Yan-Ping Hu
- Department of Medical Oncology, Hubei Cancer Hospital, Wuhan, Hubei 430079, P.R. China
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17
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Metastatic Choriocarcinoma of the Small Intestine Presenting as Refractory Anemia and Melena. ACG Case Rep J 2015; 2:131-2. [PMID: 26157939 PMCID: PMC4435411 DOI: 10.14309/crj.2015.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 03/16/2015] [Indexed: 11/26/2022] Open
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18
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Mixed germ cell tumour of mediastinum—an unusual presentation. Indian J Thorac Cardiovasc Surg 2014. [DOI: 10.1007/s12055-014-0324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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19
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Jiang F, Xiang Y, Feng FZ, Ren T, Cui ZM, Wan XR. Clinical analysis of 13 males with primary choriocarcinoma and review of the literature. Onco Targets Ther 2014; 7:1135-41. [PMID: 25018640 PMCID: PMC4074184 DOI: 10.2147/ott.s62561] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To analyze the management and prognosis of primary choriocarcinoma (PCC) in male patients. Methods The clinical records of males with PCC who were treated at Peking Union Medical College Hospital between 1990 and 2012 were analyzed retrospectively. The literature regarding this clinical condition was also reviewed. Results The median survival interval of the 13 patients treated at Peking Union Medical College Hospital was 54 months (range, 6–115 months), and the 1- and 3-year survival rates were 53.8% and 43.1%, respectively. All patients were treated with surgery; 12 were treated with combined chemotherapy. After including 100 cases found in the literature, for a total of 113 patients, the median survival interval was 10 months (range, 6.4–13.6 months). The testis was the most common primary site (36.2%). Most patients (70.9%) had metastatic lesions at diagnosis. Univariate and multivariate analyses revealed that longer median overall survival was significantly associated with patient age <34 years old (48 months vs 10 months, odds ratio [OR] =0.47, P=0.029), the presence of other histological components (54 months vs 11 months, OR =0.54, P=0.011), and combined chemotherapy and surgical treatments (14 months vs 2.5 months, OR =0.18, P=0.002). Conclusion PCC is an extremely rare disease among men, and its prognosis is much worse than that of gestational choriocarcinoma. The complete resection of the primary site and metastases followed by chemotherapy seems to provide patients with the best chance at survival. Furthermore, additional chemotherapy cycles might facilitate better progress.
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Affiliation(s)
- Fang Jiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Feng-Zhi Feng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Tong Ren
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zhu-Mei Cui
- Department of Obstetrics and Gynecology, the Affiliated Hospital of the Medical College, Qingdao University, Qingdao, People's Republic of China
| | - Xi-Run Wan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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20
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Gaude GS, Patil P, Malur PR, Kangale R, Dhorigol V, Anurshetru S, Karanji J. Primary mediastinal choriocarcinoma. South Asian J Cancer 2014; 2:79. [PMID: 24455559 PMCID: PMC3876645 DOI: 10.4103/2278-330x.110495] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gajanan S Gaude
- Department of Pulmonary Medicine, JN Medical College, Belgaum, India
| | - Pradeep Patil
- Department of Radiodiagnosis and Imaging, JN Medical College, Belgaum, India
| | | | - Ranjit Kangale
- Department of Pathology, JN Medical College, Belgaum, India
| | | | | | - Jyothi Karanji
- Department of Pulmonary Medicine, JN Medical College, Belgaum, India
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21
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Sekine R, Hyodo M, Kojima M, Meguro Y, Suzuki A, Yokoyama T, Lefor AT, Hirota N. Primary hepatic choriocarcinoma in a 49-year-old man: Report of a case. World J Gastroenterol 2013; 19:9485-9489. [PMID: 24409080 PMCID: PMC3882426 DOI: 10.3748/wjg.v19.i48.9485] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/24/2013] [Accepted: 11/13/2013] [Indexed: 02/06/2023] Open
Abstract
We report a case of hepatic choriocarcinoma in a man diagnosed at autopsy after a rapid downhill clinical course. The patient was a 49-year-old man who presented with acute right-sided abdominal pain. There were no masses palpable on physical examination. Radiographic findings showed large multi-nodular tumors mainly in the right lobe of the liver. Fludeoxyglucose-positron emission tomography scan showed uptake only in the liver, and no uptake in the testes. We initially planned to perform a liver resection for the presumed diagnosis of intra-hepatic cholangiocarcinoma. However, the tumors grew rapidly and ruptured. Multiple lung metastases rapidly developed resulting in respiratory failure, preventing liver resection or even biopsy. He died 60 d after initial presentation with no pathological diagnosis. Postmortem studies included histopathological and immunohistological examinations which diagnosed a primary choriocarcinoma of the liver. Primary hepatic choriocarcinoma is very rare but should be considered in the differential diagnosis of a liver tumor in a middle aged man. Establishing this diagnosis may enable treatment of the choriocarcinoma. Liver biopsy and evaluation of serum human chorionic gonadotropin are recommended in these patients.
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22
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Guo J, Zhong C, Liu Q, Xu J, Zheng Y, Xu S, Gao Y, Guo Y, Wang Y, Luo Q, Jiang J. Intracranial choriocarcinoma occurrence in males: Two cases and a review of the literature. Oncol Lett 2013; 6:1329-1332. [PMID: 24179518 PMCID: PMC3813813 DOI: 10.3892/ol.2013.1570] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 08/30/2013] [Indexed: 12/20/2022] Open
Abstract
Choriocarcinomas generally develop in females. Non-gestational choriocarcinoma in males is extremely rare. The present study describes two cases of young males who were diagnosed with intracranial choriocarcinoma. One case was of an aggressive choriocarcinoma with multiple metastases to the brain, but with an unidentified origin. The patient was admitted in the terminal stage of the cancer. Although a tumor resection was performed, the condition of the patient rapidly deteriorated and chemotherapy was not recommended. The patient succumbed nine days after the surgery. The second case was of a primary ventricular choriocarcinoma. The patient was hospitalized for acute hydrocephalus caused by a mass that was located in the ventricle. Following a tumor resection, the patient underwent a course of whole-brain and spinal radiotherapy. The patient was followed up for more than half a year and remained in a good condition. The present study describes the two cases and a comprehensive review of the literature that was performed to identify similar studies that document choriocarcinomas in males.
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Affiliation(s)
- Jianyi Guo
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
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23
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Yalagachin GH. Anterior mediastinal teratoma- a case report with review of literature. Indian J Surg 2012; 75:182-4. [PMID: 24426558 DOI: 10.1007/s12262-012-0569-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 06/04/2012] [Indexed: 02/06/2023] Open
Abstract
Anterior mediastinal teratomas are rare germ cell tumors. We report a case of such rare tumor in a young adult male of 21 yrs old who presented with persistent cough of one and half month duration. Computed tomography of the chest confirmed the diagnosis as anterior mediastinal teratoma. Patient underwent a right anterolateral thoracotomy. Intraoperatively there was a large mass in the anterior mediastinum extending to right hemithorax. The mass was compressing the great vessels, adherent to chest wall, pericardium, and lung. Complete excision of the mass done. Patient underwent uneventful recovery. Histopathology reported as benign cystic teratoma.
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24
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Zechel JL, MacLennan GT, Heaney JD, Nadeau JH. Spontaneous metastasis in mouse models of testicular germ-cell tumours. ACTA ACUST UNITED AC 2011; 34:e278-87. [PMID: 21651572 DOI: 10.1111/j.1365-2605.2011.01160.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Testicular germ-cell tumours (TGCTs) are the most common cancer in young men; the incidence is increasing worldwide and they have an unusually high rate of metastasis. Despite significant work on TGCTs and their metastases in humans, absence of a mouse model of spontaneous metastasis has greatly limited our understanding of the mechanisms by which metastatic potential is acquired and on their modes of dissemination. We report a new model of spontaneous TGCT metastasis in the 129 family of mice and provide evidence that these are true metastases derived directly from primary testicular cancers rather than independently from ectopic stem cells. These putative metastases (pMETs) occur at similar frequencies among TGCT-affected males in six genetically distinct TGCT-susceptible strains and were largely found in anatomical sites that are consistent with patterns of TGCT metastasis in humans. Various lines of evidence support their pluripotency and germ-cell origin, including presence of multiple endodermal, mesodermal and ectodermal derivatives as well as cells showing OCT4 and SSEA-1 pluripotency markers. In addition, pMETs were never found in males that did not have a TGCT, suggesting that metastases are derived from primary tumours. Finally, pMETS and primary TGCTs shared several DNA copy number variants suggesting a common cellular and developmental origin. Together, these results provide the first evidence for spontaneous TGCT metastasis in mice and show that these metastases originate from primary TGCTs rather than independently from ectopic stem cells.
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Affiliation(s)
- J L Zechel
- Department of Genetics, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Institute of Pathology, Cleveland OH, USA
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25
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Hadgu A, Tindni A, Panda M. Primary pulmonary choriocarcinoma in a male. BMJ Case Rep 2010; 2010:2010/jun28_1/bcr0220102712. [PMID: 22753160 DOI: 10.1136/bcr.02.2010.2712] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors report a case of a 48-year-old male smoker who presented with respiratory distress and constitutional symptoms along with gynaecomastia and multiple pulmonary nodules. Based on normal physical and ultrasound findings of the testes, presence of markedly elevated serum β human chorionic gonadotrophin (HCG) and biopsy findings of the lung a diagnosis of primary pulmonary choriocarcinoma was made.
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Affiliation(s)
- Akberet Hadgu
- College of Medicine, University of Tennessee, Chattanooga, Tennessee, USA.
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26
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Yokoi K, Tanaka N, Furukawa K, Ishikawa N, Seya T, Horiba K, Kanazawa Y, Yamada T, Ohaki Y, Tajiri T. Male choriocarcinoma with metastasis to the jejunum: a case report and review of the literature. J NIPPON MED SCH 2008; 75:116-21. [PMID: 18475033 DOI: 10.1272/jnms.75.116] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We report on a patient with male choriocarcinoma. The patient was a 31-year-old male patient with jejunal choriocarcinoma that metastasized from the mediastinum. He was admitted complaining of melena and severe anemia. Upper and lower gastrointestinal endosocopy was performed, but no source of bleeding was seen. Chest X-ray and CT revealed a mediastinal tumor 7 cm in size anterior to the arotic arch. Superior mesenteric arteriography showed irregularities and macular opacity in the jejunal artery. An emergency laparatomy was performed because of massive gastrointestinal bleeding. A jejunal tumor approximately 4 cm in size was resected and numerous metastases were observed in the liver and mesentery. Histopathological examination showed metastatic jejunal choriocarcinoma. Gynecomastia was not present and the testes were normal. Serum beta-human chorionic gonadotropin (HCG) was at an abnormally high level of 4,396 ng/mL. Because of metastases to the brain and invasion to the trachea, he died on postoperative day 20. We report this rare case of a male patient with metastases of choriocarcinoma to the gastrointestinal tract from the mediastinum, together with a review of the literature.
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Affiliation(s)
- Kimiyoshi Yokoi
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Japan.
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27
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Khan FY, Al Ani A, Allaithy MS, Al-Bozom IA. A young male with shortness of breath. Ann Thorac Med 2008; 3:28-30. [PMID: 19561881 PMCID: PMC2700432 DOI: 10.4103/1817-1737.38001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Accepted: 06/15/2007] [Indexed: 11/04/2022] Open
Abstract
We report a case of primary mediastinal seminoma, which presented initially with shortness of breath and a swelling in upper part of anterior chest wall. The diagnosis of primary mediastinal seminoma was established on the basis of histologic findings and was confirmed by immunohistochemical analysis. Abdominal, pelvis and cerebral CT scan, testicular ultrasound and TC-99 MDP bone scintigraphy were negative. Chemotherapy was initiated with B.E.P. protocol (Bleomycin, Etoposide, Cisplatinum); the patient received four cycles of chemotherapy. After 8 months, the patient was seen in the clinic; he was well.
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28
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Cheng MF, Peng YJ, Huang GS, Lee CH, Chiang PC, Lee HS. Unusual scapular metastasis as initial manifestation of advanced nonseminomatous germ cell tumor of the mediastinum. Heart Lung 2007; 36:79-84. [PMID: 17234481 DOI: 10.1016/j.hrtlng.2006.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Accepted: 05/22/2006] [Indexed: 11/20/2022]
Abstract
Primary malignant germ cell tumors of the mediastinum are relatively rare, occurring predominantly in young male adults, and have a poor prognosis. We present a case of a 27-year-old man who initially experienced a persistent, intractable painful sensation over the right lower scapula despite taking an analgesic agent for 2 months. A scapular x-ray film and a whole-body bone scan showed an expansile osteolytic lesion. Excisional biopsy of the scapula revealed a metastatic carcinoma, suggestive of nonseminomatous germ cell tumor origin. Further examination of the whole abdomen and bilateral testes were negative. Chest computed tomography and magnetic resonance imaging showed a primary tumor mass in the anterior mediastinum. Chemotherapy with cisplatin, bleomycin, and etoposide was administered for six courses. The mediastinal tumor mass was markedly reduced in size and remission without evidence of tracer uptake by [(18)F]fluorodeoxyglucose positron emission tomography examination. Six months after chemotherapy, the patient received advanced surgical intervention to remove the mediastinal tumor, the pathologic features of which were similar to the previous scapular lesion. He was doing well at 1-year follow-up.
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Affiliation(s)
- Ming-Fang Cheng
- Department of Pathology, Tri-Service General Hospital and National Defense Medical Center, Tapei, Taiwan
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29
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Yamamoto S, Tanaka H, Takeo H, Yasuda K, Mastukuma S. Primary pulmonary choriocarcinoma combined with adenocarcinoma. Pathol Int 2006; 56:402-7. [PMID: 16792550 DOI: 10.1111/j.1440-1827.2006.01977.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An extremely rare autopsy case of primary pulmonary choriocarcinoma combined with adenocarcinomatous components in a 77-year-old Japanese man is described. The patient died of rapidly progressive respiratory dysfunction without ante-mortem diagnosis. Autopsy revealed necro-hemorrhagic areas of the primary lung tumor with a typical biphasic pattern of choriocarcinoma. Topographical analysis suggested that moderately to poorly differentiated adenocarcinoma components partially surrounded the choriocarcinomatous components. Moreover, dedifferentiated carcinomatous components were scattered next to both adenocarcinomatous and choriocarcinomatous areas, and a few cells of the dedifferentiated carcinomatous components had a similar immunoreaction to conventional adenocarcinomatous or choriocarcinomatous components, such as surfactant apoprotein A, placental alkaline phosphatase or beta-human chorionic gonadotropin. Additionally, epithelial membrane antigen-positive cytotrophoblastic cells were rarely found in choriocarcinomatous areas. The present case suggests that primary lung choriocarcinoma can occur closely related to conventional pulmonary adenocarcinoma, although collision tumor was not completely ruled out.
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Affiliation(s)
- Sohei Yamamoto
- Department of Pathology, Japan Self Defense Forces Central Hospital, Tokyo, Japan
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30
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Hsiao HH, Liu YC, Tsai HJ, Tsai KB, Cheng YJ, Chou SH, Chong IW, Yang WC, Liu TC, Lin SF. Poor outcomes in patients with primary malignant mediastinal germ-cell tumors. Kaohsiung J Med Sci 2006; 21:561-5. [PMID: 16670048 DOI: 10.1016/s1607-551x(09)70208-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Primary mediastinal germ-cell tumors (GCTs) without gonadal involvement are rare and can be divided into benign mature teratoma and malignant seminoma or nonseminoma. We describe our experience of malignant mediastinal GCTs and compare the presentations and outcome with those of benign teratomas. Four malignant GCTs (1 seminoma, 1 choriocarcinoma, and 2 yolk-sac tumors) have been treated in our hospital. All patients were men with obvious symptoms before diagnosis. The patient with seminoma was treated with surgery and radiation, while those with nonseminoma tumors were treated with chemotherapy and/or surgery. Two patients died, one with extended pulmonary metastasis and the other with relapsed disease and high levels of tumor markers. Compared with the nine cases of benign teratomas, the four malignant GCTs showed overwhelming male dominance, advanced symptoms at presentation, and poor outcome. These cases highlight the important role of disease staging and tumor-marker levels in malignant GCTs, and suggest that new treatment strategies for malignant GCTs await further investigation.
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Affiliation(s)
- Hui-Hua Hsiao
- Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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31
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Shariat SF, Duchene D, Kabbani W, Mucher Z, Lotan Y. Gastrointestinal hemorrhage as first manifestation of metastatic testicular tumor. Urology 2005; 66:1319. [PMID: 16360470 DOI: 10.1016/j.urology.2005.06.102] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2005] [Revised: 05/22/2005] [Accepted: 06/22/2005] [Indexed: 11/18/2022]
Abstract
We report a case of a man with a testicular mixed germ cell tumor in whom the first symptom was severe anemia secondary to upper gastrointestinal bleeding from a metastatic pure choriocarcinoma. He underwent ileal enterectomy, radical orchiectomy, and several cycles of chemotherapy (cisplatin, etoposide, and bleomycin). He died within 41 days of diagnosis.
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Affiliation(s)
- Shahrokh F Shariat
- Department of Urology, University of Texas Southwestern Medical School, Dallas, Texas 75390-9110, USA.
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32
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Li JCM, Kan ANC, Wan SK, Chan ACW. Bleeding duodenal choriocarcinoma: An unusual cause of positive urine pregnancy test. SURGICAL PRACTICE 2005. [DOI: 10.1111/j.1744-1633.2005.00272.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Simpson L, Sundaresan R, Vohra M, Sheagren J, Cougar D, August C, Ali I. Invasive choriocarcinoma involving the major duodenal papilla. Gastrointest Endosc 2005; 61:926-8. [PMID: 15933707 DOI: 10.1016/s0016-5107(04)02842-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Lijo Simpson
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, USA
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Minamino K, Adachi Y, Okamura A, Kushida T, Sugi M, Watanabe M, Muguruma K, Sugao H, Suzuki Y, Iwasaki M, Nakano K, Koike Y, Wang J, Mukaide H, Zhang Y, Matsuda T, Matsumura M, Ikehara S. Autopsy case of primary choriocarcinoma of the urinary bladder. Pathol Int 2005; 55:216-22. [PMID: 15826249 DOI: 10.1111/j.1320-5463.2005.01814.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Choriocarcinomas usually develop in the uterus and ovaries in the female, being extremely rare in the extragenital organs in the male. Extragenital choriocarcinomas in the male usually develop in the mediastinum or retroperitoneum. The frequency of choriocarcinoma in the urinary bladder is extremely low. The purpose of the present paper was to report an autopsy case of choriocarcinoma in the urinary bladder in the male. An 81-year-old male patient with macrohematuria was first diagnosed with transitional cell carcinoma (TCC). At autopsy a hemorrhagic necrotic tumor, which was found in the urinary bladder with metastatic lesions in the lungs, was diagnosed as choriocarcinoma microscopically. There was no evidence for choriocarcinoma derived from any other organs than the urinary bladder, although there were metastatic lesions in both lungs and the direct invasion into the prostate. From these findings it is concluded that the tumor was a primary choriocarcinoma in the urinary bladder in a male patient. Choriocarcinoma of the urinary bladder is very rare, but the prognosis is extremely poor in comparison with TCC even in the urinary bladder. Therefore, it is essential to clearly discriminate between choriocarcinomas and TCC.
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Affiliation(s)
- Keizo Minamino
- First Department of Pathology, Kansai Medical University, Moriguchi, Osaka, Japan
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Wang L, Pitman MB, Castillo CFD, Dal Cin P, Oliva E. Choriocarcinoma involving the pancreas as first manifestation of a metastatic regressing mixed testicular germ cell tumor. Mod Pathol 2004; 17:1573-80. [PMID: 15545958 DOI: 10.1038/modpathol.3800226] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We describe an unusual case of metastatic choriocarcinoma of the pancreas arising from a regressing testicular mixed germ cell tumor that clinically mimicked a primary pancreatic tumor. A 54-year-old male presented with a 2-month history of progressive upper abdominal pain, weight loss, and jaundice. He also had a history of recurrent epididymitis associated with the presence of a right testicular mass shown to be cystic by ultrasound and stable for at least 10 years. A computed tomography scan showed an isolated 6 cm mass in the head of the pancreas. A pancreaticoduodenectomy was performed. Upon histological examination, the pancreatic tumor showed extensive hemorrhage and necrosis. In the viable area, the tumor was composed of an intimate mixture of mononuclear cytotrophoblast cells and multinucleated syncytiotrophoblasts with vascular invasion. These characteristic features led to the correct diagnosis on frozen section. The cytology of the tumor was nonspecific and suggested undifferentiated carcinoma of the pancreas. The trophoblastic origin of the tumor cells was confirmed by immunohistochemistry staining. The testicular mass showed a regressed mixed germ cell tumor of predominantly seminoma with focal teratoma but without a choriocarcinoma component. In conclusion, we present a rare and unusual case of a regressing testicular mixed germ cell tumor that presented as a primary pancreatic tumor. Cytological features of the pancreatic mass were not specific and raised the possibility of a primary undifferentiated carcinoma of the pancreas. Characteristic histological features of choriocarcinoma led to the correct diagnosis on frozen section. Subsequent resection of the testicular mass confirmed the presence of a cystic and scarring (regressing) mixed germ cell tumor but without evidence of choriocarcinoma.
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Affiliation(s)
- Lan Wang
- Department of Pathology, Harvard Medical School, Boston, MA 02114, USA
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Sakurai H, Asamura H, Suzuki K, Watanabe SI, Tsuchiya R. Management of Primary Malignant Germ Cell Tumor of the Mediastinum. Jpn J Clin Oncol 2004; 34:386-92. [PMID: 15342665 DOI: 10.1093/jjco/hyh062] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Primary mediastinal malignant germ cell tumors (GCTs) are rare and have a worse prognosis than their gonadal counterparts. Although multimodality treatment is a standard therapeutic strategy in mediastinal GCTs, the clinical implications of surgical intervention remain unclear. METHODS Forty-eight patients with primary mediastinal malignant GCT who were treated at the National Cancer Center Hospital, Tokyo, from 1962 to 2002 were studied retrospectively with regard to their histology and clinical profile. RESULTS Mediastinal GCT occurred predominantly in young males, with a mean age of 28.8 years at the time of diagnosis. There were 46 males (96%) and two females (4%). Histologically, seven patients (15%) were diagnosed as having pure seminoma and 41 (85%) had non-seminomatous GCT. Treatment consisted of surgery alone in nine patients, surgery followed by chemotherapy in two, and chemotherapy followed by surgery in 20. The other 17 patients received chemotherapy and/or radiotherapy without surgery. Of these latter 17 patients, 14 developed progressive disease and three were followed up with a sustained partial response. Among the 31 patients who underwent surgery, complete resection was performed in 27 (87%) and incomplete resection was performed in four (13%). Twelve (41%) patients had elevated serum tumor marker levels preoperatively. Among the 20 patients who received preoperative chemotherapy, viable cells were found in the resected specimen in six (30%). With regard to tumor recurrence in patients with surgical intervention, the preoperative serum tumor marker levels and the presence of viable cells in the resected specimen were significantly associated with recurrence. There was no significant association between surgical curability and recurrence. The 5-year overall survival rate in all 48 patients was 45.5%. CONCLUSIONS Surgical intervention for mediastinal GCT may be needed to remove a chemotherapy-refractory tumor or to assess the pathological response to chemotherapy to determine the indications for further chemotherapy.
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Affiliation(s)
- Hiroyuki Sakurai
- Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan.
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Fabre E, Jira H, Izard V, Ferlicot S, Hammoudi Y, Theodore C, Di Palma M, Benoit G, Droupy S. 'Burned-out' primary testicular cancer. BJU Int 2004; 94:74-8. [PMID: 15217435 DOI: 10.1111/j.1464-410x.2004.04904.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To report the natural history of 'burned-out' testicular tumour (a testicular tumour that has regressed spontaneously with no treatment and that generally presents at the stage of metastases). PATIENTS AND METHODS We report five cases of burned-out testicular tumours to illustrate the clinical, radiological and histopathological features, and discuss the hypothesis of natural history of these neoplasms. RESULTS The findings in the five patients tended to indicate that metastatic progression appears to induce spontaneous regression of the previous tumour site. Patients explored for extragonadal germ cell tumour present with various clinical features depending on the site of the metastases. CONCLUSION Despite the controversial hypotheses of the origin of these tumours, extragonadal germ cell tumours should be considered to be metastases of a 'burned-out' primary testicular tumour that must be investigated. When a primary testicular tumour is detected, the testis must be removed, and standard chemotherapy yields good long-term results. The hypothesis of an immunological reaction against the tumour inducing the spontaneous necrosis of the primary tumour and possibly the metastases should be considered. Immunological screening should be proposed in patients to investigate this interesting model of spontaneous tumour regression.
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Affiliation(s)
- Elodie Fabre
- Service d'Urologie, CHU Bicêtre, Bicêtre, France
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38
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Blokh I, Oiseth SJ, Fuks J, Jain D, Eapen S, Koulova L, Alexandrescu D, Li YY, Dutcher J, Wiernik PH. Metastatic choriocarcinoma in a middle-aged man presenting as a right thigh mass with venous thrombosis: a case report. Med Oncol 2003; 20:189-94. [PMID: 12835524 DOI: 10.1385/mo:20:2:189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2002] [Accepted: 12/16/2002] [Indexed: 11/11/2022]
Abstract
Choriocarcinoma is a highly aggressive beta-subunit of human chorionic gonadotropin (betaHCG)-producing germ cell tumor. In men, it is a rare neoplasm and can arise in the testes or in various extragonadal locations such as the retroperitoneum, mediastinum, and pineal body. We present a highly unusual case of a middle-aged man with primary metastatic betaHCG-producing choriocarcinoma of the right thigh along with right lower-extremity venous thrombosis. We comment on prognostic variables as well as discuss several theories to account for the unusual location of his choriocarcinoma.
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Affiliation(s)
- Ilya Blokh
- Department of Internal Medicine, Long Island Jewish Hospital, New Hyde Park, NY, USA
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Takeda SI, Miyoshi S, Ohta M, Minami M, Masaoka A, Matsuda H. Primary germ cell tumors in the mediastinum: a 50-year experience at a single Japanese institution. Cancer 2003; 97:367-76. [PMID: 12518361 DOI: 10.1002/cncr.11068] [Citation(s) in RCA: 159] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Primary germ cell tumors (GCT) of the mediastinum share similar clinical and biologic characteristics, which are different from their testicular counterpart. The purpose of the current study was to review the authors' institutional experience of mediastinal GCT, emphasizing the clinical spectrum, time trends of treatment, and recent advances in therapeutic modalities for malignant GCT. METHODS Between 1951 and 2000, 129 patients (70 males and 59 females) underwent surgical treatment for GCT, which accounted for 16.0% of the mediastinal tumors during the same period. There were 95 patients with mature teratomas, 13 patients with seminomas, and 21 patients with nonseminomatous germ cell tumors (NSGCT) with median ages of 26.4 years, 27.6 years, and 28.5 years, respectively. RESULTS Adult patients with mature teratomas were less symptomatic (33.3%) than pediatric patients (52.4%). All patients with mature teratoma were cured by resection alone. Eight of the 13 patients (61.5%) with seminoma were symptomatic and 10 of 13 patients (83.3%) survived after surgery and radiation with/without chemotherapy. Nineteen of 21 patients (90.5%) with NSGCT had dyspnea, chest pain, and superior vena cava syndrome. Before 1985, patients received radical resection and/or chemoradiotherapy. However, all patients died due to disease progression, with a median survival period of 7.6 months. After 1986, six of eight patients received cisplatin-based chemotherapy, including three who received additional high-dose chemotherapy with a supporting peripheral blood stem cell transplantation until tumor markers normalized. Five patients who underwent salvage resection are currently disease free with a median survival period of 58.3 months. CONCLUSIONS The institutional experience indicates the benign nature of mediastinal mature teratomas and the excellent prognosis for patients with seminomas after resection. An improved survival advantage was ensured with cisplatin-based preoperative chemotherapy in patients with NSGCT.
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Affiliation(s)
- Shin-ichi Takeda
- Department of Surgery, Course of Interventional Medicine (E1), Osaka University Graduate School of Medicine, Osaka, Japan.
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Tsai JR, Chong IW, Hung JY, Tsai KB. Use of urine pregnancy test for rapid diagnosis of primary pulmonary choriocarcinoma in a man. Chest 2002; 121:996-8. [PMID: 11888991 DOI: 10.1378/chest.121.3.996] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Primary pulmonary choriocarcinoma is an extremely rare tumor in men, with 13 cases reported in the literature. Due to its rarity, primary choriocarcinoma of the lung in men is often incorrectly diagnosed as more common diseases, such as primary or metastatic lung cancer, and therefore potentially curative chemotherapy or surgery may be withheld from the patient. In this report, we present the case of a 23-year-old man with hemoptysis and progressive dyspnea. Airspace consolidation with multiple nodules of varying sizes was found on a chest radiograph. The results of a urine pregnancy test were positive, and the beta-human chorionic gonadotropin level was markedly elevated both in the serum and the urine. Subsequently, testing of a bronchoscopic biopsy specimen proved these tumors to be choriocarcinoma. We conclude that the urine pregnancy test, a simple and convenient method, would be very useful in the rapid diagnosis of primary pulmonary choriocarcinoma in men.
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Affiliation(s)
- Jong-Rung Tsai
- Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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41
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Liu AY, Chan WY, Ng EK, Zhang X, Li BC, Chow JH, Chung SC. Gastric choriocarcinoma shows characteristics of adenocarcinoma and gestational choriocarcinoma: a comparative genomic hybridization and fluorescence in situ hybridization study. DIAGNOSTIC MOLECULAR PATHOLOGY : THE AMERICAN JOURNAL OF SURGICAL PATHOLOGY, PART B 2001; 10:161-5. [PMID: 11552718 DOI: 10.1097/00019606-200109000-00003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The authors report two cases of the rare primary gastric choriocarcinoma. These tumors showed an overwhelming predominance of cytotrophoblast- and syncytiotrophoblast-like tumor cells that were positive for beta-human chorionic gonadotrophin, with small foci of glandular differentiation. Beta-human chorionic gonadotrophin was also detected serologically in one patient. Comparative genomic hybridization study was performed on one specimen. Copy number gains of chromosomes 12, 17, 20, 22, and X, together with losses on 18q, were the major findings. Except for the gain of chromosome 12, which is known to be uncommon in primary gastric adenocarcinoma but frequently associated with choriocarcinoma, the remaining genomic imbalances were among the most common comparative genomic hybridization findings reported in primary gastric adenocarcinoma. Fluorescence in situ hybridization on paraffin sections of both specimens confirmed the presence of polysomy 17 and trisomy 12. These results suggest that primary gastric choriocarcinoma genetically possesses characteristics of both adenocarcinoma and gestational choriocarcinoma. The authors believe this is the first interphase cytogenetics study on this rare tumor, and that the results support the theory that gastric choriocarcinoma arises from alternate differentiation pathways of adenocarcinoma.
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Affiliation(s)
- A Y Liu
- Department of Anatomical & Cellular Pathology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT
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42
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Campbell PA, McKendrick J. Choriocarcinoma of the urinary bladder. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1999; 69:533-7. [PMID: 10442930 DOI: 10.1046/j.1440-1622.1999.01607.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- P A Campbell
- Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia
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44
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Chan GS, Ng WK, Chua DT, Wu PC. Raised serum hCG in a male patient caused by primary jejunal choriocarcinoma. J Clin Pathol 1998; 51:413-5. [PMID: 9708216 PMCID: PMC500710 DOI: 10.1136/jcp.51.5.413] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A rare case of primary choriocarcinoma of the jejunum occurred in a 45 year old Chinese man. This tumour was associated with massive melaena and a markedly raised serum human chorionic gonadotrophin (beta-hCG) concentration. Necropsy examination showed no primary lesion in other possible sites including testes, mediastinum, and pineal gland. Histologically, the tumour showed morphology typical of choriocarcinoma with no adenocarcinomatous element identified. The presence of choriocarcinoma in non-gonadal sites may be explained by retrodifferentiation or metaplasia of a conventional carcinomatous component to primitive trophoblasts. Serum beta-hCG level may represent a useful marker in earlier diagnosis and monitoring of this potentially treatable disease.
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Affiliation(s)
- G S Chan
- Department of Pathology, University of Hong Kong, Queen Mary Hospital, Hong Kong
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PACHTER MR, LATTES R. "GERMINAL" TUMORS OF THE MEDIASTINUM: A CLINICOPATHOLOGIC STUDY OF ADULT TERATOMAS, TERATOCARCINOMAS, CHORIOCARCINOMAS AND SEMINOMAS. ACTA ACUST UNITED AC 1996; 45:301-10. [PMID: 14132277 DOI: 10.1378/chest.45.3.301] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Otsuka T, Ohshima Y, Sunaga Y, Nagashima K. Primary pulmonary choriocarcinoma in a four month old boy complicated with precocious puberty. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1994; 36:404-7. [PMID: 7942004 DOI: 10.1111/j.1442-200x.1994.tb03210.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A four month old boy with pulmonary choriocarcinoma, showing iso-sexual precocious puberty is reported. His serum human chorionic gonadotropin (HCG) was highly elevated. A round isolated tumor in the right lung, found by chest X-ray, magnetic resonance imaging and gallium scintigraphy, was removed surgically a month and a half after clinical manifestations were noticed. It was determined to be choriocarcinoma on the basis of histological findings and positive HCG on histochemical examination. Skull irradiation and chemotherapy (cisplatinum, vinblastine and bleomycin) had only a transient effect on reducing tumor size and normalizing the serum level of HCG. This case suggests that a more effective treatment regimen needs to be established.
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Affiliation(s)
- T Otsuka
- Department of Pediatrics, Gunma University School of Medicine, Japan
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49
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Kim SN, Chi JG, Kim YW, Dong ES, Shin HY, Ahn HS, Kim CW. Neonatal choriocarcinoma of liver. PEDIATRIC PATHOLOGY 1993; 13:723-30. [PMID: 8108292 DOI: 10.3109/15513819309048259] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Neonatal choriocarcinoma associated with a seemingly normal gestation is rare. A total of 20 cases of either primary or metastatic choriocarcinoma in infancy have been reported until 1992. We report an additional case of a huge choriocarcinoma of the liver in a 2-month-old boy, who died of tumor hemorrhage. This baby was born to a 19-year-old unmarried mother. The placenta was thought to be normal and was not examined histologically. The liver mass was first noted 2 weeks after birth, and he was admitted because of poor feeding and pallor. Before any therapy was instituted, he died of massive tumor bleeding. Autopsy revealed a huge hemorrhagic tumor mass with massive necrosis in the left lobe of the liver. Several nodular metastases were found only in the lung. The remainder was unremarkable except for bilateral cleft lip and palate. It is presumed that the choriocarcinoma in the liver could be either a primary tumor in the absence of any primary focus in the mother or the infant or a metastatic lesion from an occult choriocarcinoma of the placenta.
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Affiliation(s)
- S N Kim
- Department of Pathology, Seoul National University College of Medicine, Korea
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50
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Grammatico D, Grignon DJ, Eberwein P, Shepherd RR, Hearn SA, Walton JC. Transitional cell carcinoma of the renal pelvis with choriocarcinomatous differentiation. Immunohistochemical and immunoelectron microscopic assessment of human chorionic gonadotropin production by transitional cell carcinoma of the urinary bladder. Cancer 1993; 71:1835-41. [PMID: 8448745 DOI: 10.1002/1097-0142(19930301)71:5<1835::aid-cncr2820710519>3.0.co;2-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND There have been 12 documented cases of choriocarcinoma arising in the urinary bladder, either alone or in combination with other epithelial tumors. It has been shown that some high-grade transitional cell carcinomas (TCC), without obvious syncytiotrophoblastic elements, can produce human chorionic gonadotrophins (HCG). METHODS A case of choriocarcinoma, in association with high-grade TCC of the renal pelvis, was encountered in an 80-year-old man. For additional evaluation of HCG production by TCC, 25 consecutive cases of invasive high-grade TCC of the bladder were stained with an anti-HCG antibody. Immunogold staining also was performed in two of the cases studied. RESULTS Immunoperoxidase staining of the renal pelvis tumor showed focal positivity for HCG within the TCC and a more intense reaction as the tumor cells differentiated into choriocarcinoma elements. Seven of the 25 cases (28%) displayed varying degrees of reactivity within individual cells or groups of cells. In an additional case, typical syncytiotrophoblastic giant cells without cytotrophoblasts were seen in a high-grade TCC. Immunogold studies demonstrated positive labeling in the cytoplasm of carcinoma cells in a case of TCC without syncytiotrophoblasts and in the syncytiotrophoblastic giant cells in the one case in which these were present. CONCLUSIONS The findings support a metaplastic origin of cases of choriocarcinoma arising primarily in the urothelial tract.
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Affiliation(s)
- D Grammatico
- Department of Pathology, Victoria Hospital, London, Ontario, Canada
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