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Xu J, Xu Y, Xu C, Wang C. Morphological and molecular pathological features of the breast carcinoma with choriocarcinomatous features: A case report and a literature review. Front Oncol 2023; 13:984425. [PMID: 36969041 PMCID: PMC10031012 DOI: 10.3389/fonc.2023.984425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
Here we present a rare case of breast cancer with both invasive ductal carcinoma and choriocarcinoma components in a 55-year-old woman. Firstly, the serum human chorionic gonadotropin level showed 15.9mIU/ml preoperatively. And adequate immunohistochemical tests were performed on the specimen. Secondly, High-throughput sequencing was performed to detect the molecular characteristics of the two components, respectively. Then, DNA short tandem repeat (STR) analysis confirmed the homology of the two components, indicating the somatic origin of choriocarcinoma components. Finally, the clinical course and pathological characteristics of the case were reviewed and a literature search for other cases was performed.
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Mehta KK, Nouvini R, Liu J, Wang Y, Stopeck A. Case report: Metastatic metaplastic breast cancer with choriocarinomatous features: Targeting the choriocarcinoma component for cure. Front Oncol 2022; 12:1061679. [PMID: 36686740 PMCID: PMC9850144 DOI: 10.3389/fonc.2022.1061679] [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: 10/04/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023] Open
Abstract
Breast cancer with choriocarcinomatous features (BCCF) is a rare and aggressive breast cancer. BCCF carries a poor prognosis and there is unfortunately scant literature to guide treatment beyond surgical resection with most patients receiving standard regimens for breast cancer. In our case, we present a 42-year-old female with an initial hCG of 2,324 and two suspicious lesions of the right breast. On biopsy, each lesion had distinct histopathology with the larger lesion diagnosed as BCCF and the smaller lesion being an invasive ER/PR positive ductal carcinoma. The diagnosis of BCCF rather than metastatic choriocarcinoma was confirmed using DNA typing. Salvage chemotherapy targeting choriocarcinoma resulted in marked clinical and biomarker success including normalization of the hCG. After recurrent brain metastases were diagnosed, high dose chemotherapy with methotrexate was administered resulting in long term remission.
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Affiliation(s)
- Krisha K Mehta
- Department of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Rosa Nouvini
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jingxuan Liu
- Department of Pathology, Stony Brook University, Stony Brook, NY, United States
| | - Yi Wang
- Department of Pathology, Stony Brook University, Stony Brook, NY, United States
| | - Alison Stopeck
- Department of Medicine, Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, United States
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Zhu Y, Liu M, Li J, Jing F, Linghu R, Guo X, Jiao S, Yang J. Breast carcinoma with choriocarcinomatous features: a case report and review of the literature. World J Surg Oncol 2014; 12:239. [PMID: 25073898 PMCID: PMC4121303 DOI: 10.1186/1477-7819-12-239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 04/30/2014] [Indexed: 11/17/2022] Open
Abstract
Background Breast carcinoma with choriocarcinomatous features (BCCF) is a rare variant of breast cancer, characterized by high expression of human chorionic gonadotropin (HCG) in cancer cells such as multinucleated syncytiotrophoblast-like giant cells. The first case of BCCF was reported in 1981 by Saigo and Rosen. Only one case of BCCF was reported to show no component of breast ductal carcinoma, and only partially cancer cells, such as multinucleated syncytiotrophoblast-like giant cells, expressed HCG in all previous BCCF cases. Here, we report the first BCCF case without any component of breast ductal carcinoma in which HCG was found to express in all cancer cells. Case presentation A 32-year-old female patient presented with a small lump in her left breast 3 years prior. The mass was clinically suspected to be breast infiltrating ductal carcinoma based on breast excisional biopsy and magnetic resonance imaging findings. Due to rupture and bleeding of the left kidney, the left kidney excisional biopsy was performed. After a retrospective analysis of the initial excised breast cancer and breast cancer metastatic to the kidney, the cancer cells were positive for HCG by immunohistochemistry, and multinucleated or mononucleated giant cells resembled syncytiotrophoblastic and cytotrophoblastic cells which could be seen in a background of poor differentiated breast carcinoma and extensive necrosis and hemorrhage in the lesion. Thus, a final diagnosis of BCCF and BCCF metastatic to the kidney was made. After combination of surgical resection (the affected left breast and left kidney wereremoved) and consecutive chemotherapy consisting of docetaxel, epirubicin, cisplatin, lobaplatin, and capecitabine, the patient achieved favorable therapeutic efficacy (the HCG level returned to normal values, the metastatic lesions in the lungs disappeared, and the survival was 37 months). Capecitabine was very efficient and highly recommended due to its superior efficacy in reducing the HCG level and eliminating the metastatic lesions in the lungs. Conclusions This is the first report of a rare case of BCCF without any component of breast ductal carcinoma, featured by high expression of HCG in all cancer cells. Combination of surgery and chemotherapy (especially capecitabine) achieved a favorable therapeutic efficacy.
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Affiliation(s)
| | | | | | | | | | | | - Shunchang Jiao
- Department of Medical Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China.
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Sung HJ, Maeng YI, Kim MK, Lee SJ, Kang SM, Bong JG, Oh HK. Breast carcinoma with choriocarcinomatous features: a case report. J Breast Cancer 2013; 16:349-53. [PMID: 24155767 PMCID: PMC3800734 DOI: 10.4048/jbc.2013.16.3.349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/04/2013] [Indexed: 11/30/2022] Open
Abstract
Nongestational choriocarcinoma differentiation is extremely rare in breast neoplasms. It is characterized by tumor cells similar to chorionic trophoblastic cells, which react with human placental lactogen and human chorionic gonadotropin (hCG). A 56-year-old woman presented with a palpable right breast mass without past history of trophoblastic tumors. An F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan revealed one focus with low accumulation of FDG in the right breast (maximum standardized uptake value, 1.98). The patient underwent a right mastectomy and biopsy of sentinel nodes. Microscopically, the tumor was a typical invasive ductal carcinoma with multiple foci of choriocarcinoma features. Immunohistochemistry showed that the tumor cells resembling choriocarcinoma were positive for hCG antibody, but negative for HER2/neu, estrogen receptor, and progesterone receptor. A pathologic diagnosis of breast carcinoma with choriocarcinomatous features was made. To our knowledge, this is the first report of invasive carcinoma with choriocarcinomatous features and an unusual finding of low accumulation in an F-18 FDG PET/CT scan in Korea.
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Affiliation(s)
- Hyun-Jung Sung
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea. ; Department of Pathology, Goodsamaritan Hospital, Pohang, Korea
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5
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Mohammadi A, Rosa M. Carcinoma of the Breast With Choriocarcinomatous Features. Arch Pathol Lab Med 2011; 135:1097-100. [DOI: 10.5858/2010-0334-rsr1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Choriocarcinomatous differentiation has been described in tumors arising from many organs including lung, rectum, colon, stomach, bladder, and rarely breast. Mammary carcinoma with choriocarcinomatous features is a rare variant of breast metaplastic carcinoma characterized by malignant cells morphologically resembling choriocarcinoma cells in which reactivity with human placental lactogen and human chorionic gonadotropin can be demonstrated by immunohistochemistry. The characteristic syncytiotrophoblast-like giant cells seen in these neoplasms are more commonly associated with moderately to poorly differentiated carcinomas with or without a clear-cut mesenchymal component. Most of the reported cases have behaved very aggressively. The reason for this poor prognosis remains unclear. Because of the small number of cases, special treatment protocols have not been developed and these patients are treated surgically and with the standard chemotherapeutic agents available for other types of carcinoma of the breast. Pathologically, these tumors must be distinguished from metastatic choriocarcinoma to the breast.
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Murata T. Pathology service and practice: solo-practice pathologist in a community hospital in Japan: personal experience and a proposal for cost- and time-effective practice. Pathol Int 2006; 56:480-3. [PMID: 16872446 DOI: 10.1111/j.1440-1827.2006.01994.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Siddiqui NH, Cabay RJ, Salem F. Fine-needle aspiration biopsy of a case of breast carcinoma with choriocarcinomatous features. Diagn Cytopathol 2006; 34:694-7. [PMID: 16955470 DOI: 10.1002/dc.20485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Breast disease is of great concern to patients and health care providers alike. Malignancies of the breast and their various presentations can pose tremendous challenges with respect to early diagnosis and effective treatment. Carcinoma of the breast may appear in several forms and produce one or more ectopic substances. Breast carcinomas that display choriocarcinomatous differentiation and produce human chorionic gonadotropin are very rare. Less than a dozen such cases have been described in the medical literature to date. We report a case of breast carcinoma with choriocarcinomatous features, which is the first to show immunohistochemical evidence of the expression of both estrogen receptor and progesterone receptor. We also discuss the cytopathologic aspects observed and conduct a literature review.
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Affiliation(s)
- Noman H Siddiqui
- Department of Pathology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
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Le Bret T, Tranbaloc P, Benbunan JL, Salet-Lizée D, Villet R. Choriocarcinome utérin en péri-ménopause. ACTA ACUST UNITED AC 2005; 34:85-9. [PMID: 15767921 DOI: 10.1016/s0368-2315(05)82674-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a case of a primary uterine choriocarcinoma associated with adenocarcinoma occurring during peri-menopausal age, and review the literature. The clinical course and the histopathology of the case were reviewed and a Medline literature search for other cases was performed. BHCG and analysis of uterine curettage provided the diagnosis of choriocarcinoma. Polychemotherapy, started immediately after the patient's clinical condition deteriorated, was successful. Colpohysterectomy and pelvic lymphadenectomy were performed 5 months later. Treatment was completed by vaginal curietherapy. Histopathologic examination of the surgical specimen revealed only adenocarcinoma. The patient was followed for 18 months without evidence of recurrence. The literature search revealed that primary forms are exceptional; the etiology is unknown. Treatment is based on polychemotherapy. Primary choriocarcinomas are rare tumours, associated with other histopathological forms. We document a case occurring during the peri-menopausal period and review the literature on this pathology. The very poor prognosis in the past has changed with early polychemotherapy.
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Affiliation(s)
- T Le Bret
- Service de Chirurgie Viscérale et Gynécologique, Hôpital des Diaconesses, 12, rue du Sergent-Bauchat, 75012 Paris.
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Abstract
Although breast carcinomas have been shown to produce various ectopic substances, including human chorionic gonadotropin, it is rare to identify morphologic differentiation compatible with the hormone produced by a tumor. Presently, only eight cases of breast carcinoma with focal choriocarcinomatous differentiation have been reported in the literature. This article describes the pathologic findings, immunohistochemical profile, and clinical course in two additional cases of this unusual variant of breast carcinoma. In the first case, the tumor had morphologic features suggestive of medullary carcinoma, and the patient is doing well 12 months after presentation. In the second case, the tumor was locally advanced at presentation with histologic features consistent with metaplastic carcinoma having squamous, sarcomatoid, and choriocarcinomatous elements. The patient presented with extensive multifocal metastases 6 months after the initial presentation and is not responding well to standard or experimental treatment regimen. Immunostaining for the beta subunit of human chorionic gonadotropin was localized mostly, but not entirely, to multinucleated syncytiotrophoblast-like giant cells within both tumors.
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Affiliation(s)
- Erika Resetkova
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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Erhan Y, Ozdemir N, Zekioglu O, Nart D, Ciris M. Breast carcinomas with choriocarcinomatous features: case reports and review of the literature. Breast J 2002; 8:244-8. [PMID: 12100118 DOI: 10.1046/j.1524-4741.2002.08411.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Breast cancer with choriocarcinomatous features is rare. This report describes four cases of breast cancer with choriocarcinomatous features. The tumor cells were positive for human placental lactogen (hPL) and human chorionic gonadotropin (hCG) by immunohistochemistry. The cases reported in the literature had a poor prognosis and the patients died within a few months after the diagnosis. In this series, two cases were lost to follow-up, but the other two have had disease-free survival for 2 and 4 years, respectively.
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Affiliation(s)
- Yildiz Erhan
- Department of Pathology, Ege University School of Medicine, Bornova, Izmir, Turkey
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Giannotti Filho O, Miiji LN, Vainchenker M, Gordan AN. Breast cancer with choriocarcinomatous and neuroendocrine features. SAO PAULO MED J 2001; 119:154-5. [PMID: 11500791 DOI: 10.1590/s1516-31802001000400009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Breast cancer may express the presence of b-human chorionic gonadotrophin in 12% to 18% of cases, using immunohistochemical reactions. Usually the tumors will show positivity in a few scattered cells. Breast cancer with choriocarcinomatous features, as reported by Saigo and Rosen, is a distinct variant of breast cancer. We report a case of breast cancer with choriocarcinomatous and neuroendocrine features. OBJECTIVE This is a case report of an invasive ductal carcinoma of the breast with choriocarcinomatous and neuroendocrine features. DESIGN Case Report. CASE REPORT A 50-year-old Brazilian woman underwent surgery for a lump in the right breast, which had been first noticed about 3 months earlier. The surgery consisted of quadrantectomy followed by right mastectomy with ipsilateral axillary lymph node dissection. The specimen from the quadrantectomy revealed a 7 x 6.5 x 4.5 cm tumor. Histology of the lesion showed the presence of an invasive ductal carcinoma with areas of giant cells and intense atypia. The immunohistochemistry was positive in the pleomorphic areas for human chorionic gonadotrophin, while the less pleomorphic areas showed positivity for synaptophysin and chromogranin.
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Affiliation(s)
- O Giannotti Filho
- Department of Pathology, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, Brazil.
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