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Matsuyama T, Kubota K, Tsuruzono K, Uchida H, Hamasaki T, Mizuno K, Inoue H. Primary mediastinal choriocarcinoma requiring differentiation from non-small cell lung cancer: An autopsy case report. Respir Med Case Rep 2024; 50:102037. [PMID: 38803367 PMCID: PMC11128503 DOI: 10.1016/j.rmcr.2024.102037] [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: 01/16/2024] [Revised: 05/03/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
A 65-year-old man with dyspnea and hemoptysis presented with a right upper lobe mass associated with enlarged mediastinal lymph nodes and bilateral pulmonary nodules on chest computed tomography (CT), suspected lung cancer. Bronchial and CT-guided biopsies revealed poorly differentiated carcinoma. His condition deteriorated rapidly before a definitive diagnosis could be made. Autopsy revealed primary mediastinal choriocarcinoma. Primary mediastinal choriocarcinomas are rare, difficult to diagnose early and have a poor prognosis. In patients with a tumor expanding across the lung and mediastinum and exhibiting pathologic findings of a pooly differentiated carcinoma, we should consider choriocarcinoma, evaluating the serum β-human chorionic gonadotropin levels.
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Affiliation(s)
- Takahiro Matsuyama
- Department of Pulmonary Medicine, Imakiire General Hospital, 43-25 Kouraicho, Kagoshima City, 890-0051, Kagoshima, Japan
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Kagoshima, Japan
| | - Koji Kubota
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Kagoshima, Japan
| | - Kentaro Tsuruzono
- Department of Pulmonary Medicine, Imakiire General Hospital, 43-25 Kouraicho, Kagoshima City, 890-0051, Kagoshima, Japan
| | - Hiroko Uchida
- Department of Pulmonary Medicine, Imakiire General Hospital, 43-25 Kouraicho, Kagoshima City, 890-0051, Kagoshima, Japan
| | - Tetsuro Hamasaki
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Kagoshima, Japan
| | - Keiko Mizuno
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Kagoshima, Japan
| | - Hiromasa Inoue
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Kagoshima, Japan
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2
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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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3
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Wang H, Chen X, Zhang R. Primary mediastinal choriocarcinoma in an 18-year-old male with pulmonary and brain metastasis: A case report. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:1082-1087. [PMID: 37614074 PMCID: PMC10543098 DOI: 10.1111/crj.13691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/25/2023]
Abstract
Primary mediastinal choriocarcinoma, also known as non-pregnant choriocarcinoma, is a rare malignancy unrelated to pregnancy, with a higher incidence in males. And primary mediastinal choriocarcinoma is mostly associated with organ and lymph node metastasis, with rapid progression and poor prognosis. Here, we report an extremely rare case of the primary anterior mediastinal choriocarcinoma that occurred in an 18-year-old man with multiple metastases of the lung and brain.
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Affiliation(s)
- Hanlin Wang
- Department of Thoracic SurgeryThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Xiu Chen
- Department of Thoracic SurgeryThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Renquan Zhang
- Department of Thoracic SurgeryThe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
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Iso H, Hisakane K, Terashi N, Mikami E, Matsuki S, Sonokawa T, Atsumi K, Yoshino N, Nagata K, Seike M, Hirose T. A remarkable response to combination chemotherapy with nivolumab and ipilimumab in a patient with primary pulmonary choriocarcinoma: a case report. Transl Cancer Res 2023; 12:2212-2218. [PMID: 37701113 PMCID: PMC10493795 DOI: 10.21037/tcr-23-221] [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: 02/18/2023] [Accepted: 06/27/2023] [Indexed: 09/14/2023]
Abstract
Background Primary pulmonary choriocarcinoma (PPC) is a rare malignancy, and only 41 PPC cases have been reported in males up to 2021. Due to its rarity, no standardized treatments for PPC have been established. Cytotoxic chemotherapy has limited efficacy, and the prognosis of advanced PPC is notably poor. Immune checkpoint inhibitors (ICIs) are expected to provide long-term survival for PPC patients, but only a few cases have been reported. The optimal treatment for PPC has not been determined. Case Description Here, we report a 72-year-old male with post-surgery relapsed PPC, presenting with multiple pulmonary nodules and an intracardiac mass. The OncomineTM Dx target test showed no mutation of cancer-relevant genes, and programmed death-ligand 1 (PD-L1) expression was negative (0%) in the 22C3 assay. He received a combination of carboplatin, paclitaxel, nivolumab, and ipilimumab which is widely used as a first-line treatment for advanced non-small-cell lung cancer (NSCLC). Two months after treatment began, computed tomography (CT) showed multiple lung nodules and an intracardiac mass reduction, which has been sustained for 12 months. Grade 3 febrile neutropenia and grade 2 rash were observed, however, these adverse events were manageable. Conclusions This is the first case of postoperative relapse PPC that has been successfully treated with the combination of chemotherapy, nivolumab, and ipilimumab. This therapy may be a promising option for advanced PPC.
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Affiliation(s)
- Hirokazu Iso
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan
| | - Kakeru Hisakane
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan
| | - Naoki Terashi
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan
| | - Erika Mikami
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan
| | - Satoru Matsuki
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan
| | - Takumi Sonokawa
- Department of Thoracic Surgery, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan
| | - Kenichiro Atsumi
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan
| | - Naoyuki Yoshino
- Department of Thoracic Surgery, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan
| | - Kohji Nagata
- Department of Pathology, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takashi Hirose
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan
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Lew CZ, Liu HC, Hou JY, Huang TH, Yeh TC. Pediatric Extracranial Germ Cell Tumors: Review of Clinics and Perspectives in Application of Autologous Stem Cell Transplantation. Cancers (Basel) 2023; 15:cancers15071998. [PMID: 37046659 PMCID: PMC10093083 DOI: 10.3390/cancers15071998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023] Open
Abstract
Pediatric extracranial germ cell tumors (GCTs) are rare, accounting for approximately 3.5% of childhood cancers. Since the introduction of platinum-based chemotherapy, the survival rate of patients has improved to more than 80%. However, poor-risk subtypes of pediatric extracranial GCTs do not respond well to chemotherapy, leading to refractory or relapsed (R/R) diseases. For example, long-term survival rates of mediastinal GCTs or choriocarcinoma are less than 50%. According to reports in recent years for adult patients with R/R GCTs, the use of high-dose chemotherapy (HDCT) combined with autologous stem cell transplantation (ASCT) has clinical advantages; however, HDCT combined with ASCT has rarely been reported in pediatric GCTs. The R/R and poor-risk groups of pediatric GCTs could benefit from HDCT and ASCT.
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Affiliation(s)
- Chong-Zhi Lew
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Children’s Hospital, Mackay Medical College, Taipei 104, Taiwan
| | - Hsi-Che Liu
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Children’s Hospital, Mackay Medical College, Taipei 104, Taiwan
| | - Jen-Yin Hou
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Children’s Hospital, Mackay Medical College, Taipei 104, Taiwan
| | - Ting-Huan Huang
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Hsinchu Mackay Memorial Hospital, Hsinchu 300, Taiwan
| | - Ting-Chi Yeh
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Mackay Children’s Hospital, Mackay Medical College, Taipei 104, Taiwan
- Correspondence:
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Pakkala AK, Nekarakanti PK, Nagari B, Bansal AK, Shroff G, Uppin MS. Primary Hepatic Choriocarcinoma with Pregnancy: A Diagnostic and Therapeutic Challenge. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2023; 81:91-94. [PMID: 36824037 DOI: 10.4166/kjg.2022.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/12/2022] [Accepted: 12/06/2022] [Indexed: 02/25/2023]
Abstract
Choriocarcinoma occurs mainly in the gonads, but an extragonadal origin has been reported, albeit infrequently. Primary hepatic choriocarcinoma (PHC) is a rare malignancy, with only 11 cases reported. Most cases reported were in males, with none reported in pregnant females. A 23-year-old primigravida presented with a large liver lesion involving the right lobe of the liver at 28 weeks of pregnancy. Preoperative imaging was suggestive of hepatocellular carcinoma. She underwent a non-anatomical resection of the liver lesion. Surprisingly, her postoperative histopathology revealed a diagnosis of PHC. Her blood workup showed elevated beta human chorionic gonadotrophin. She underwent a termination of her pregnancy at 32 weeks. Before initiating adjuvant chemotherapy four weeks after surgery, a whole-body PET scan revealed multiple bi-lobar liver and pelvic deposits. After a multidisciplinary team discussion, she was started on adjuvant chemotherapy. She is currently under regular follow-up, seven months post-surgery. PHC, one of the vascular lesions of the liver, poses a diagnostic and therapeutic challenge, warranting a multidisciplinary approach.
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Affiliation(s)
- Amith Kumar Pakkala
- Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Phani Kumar Nekarakanti
- Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Bheerappa Nagari
- Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ashish Kumar Bansal
- Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Gourang Shroff
- Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Megha S Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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7
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Liu D, Ye Q, Ye M, Yang Y. Primary Anterior Medistinal Choriocarcinoma in Male with Lung Metastasis and Pituitary Microadenoma: A Case Report. Case Rep Oncol 2023; 16:1518-1527. [PMID: 38045429 PMCID: PMC10688996 DOI: 10.1159/000533476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/14/2023] [Indexed: 12/05/2023] Open
Abstract
The authors report a case of a 29-year-old male presented with bilateral breast enlargement with no significant past medical history or estrogen exposure. Serum β-human chorionic gonadotropin (HCG) was 14,306.60 mIU and positron emission tomography-computed tomography discovered a malignant mass on the right side of anterior superior mediastinum. Magnetic resonance imaging demonstrated pituitary microadenoma. Pathological biopsy showed poorly differential pituitary adenoma and immunohistochemical staining displayed that CK(+), PLAP(-), AFP(-), HCG(+), CD30(-), Oct3/4(-), CK7(+), TTF-1(-), CD117(-), Ki 67(80+), CK5/6(-), EMA(partial+), inhibin(partial+). A diagnosis of primary anterior mediastinal choriocarcinoma metastasis to bilateral lungs accompanied with pituitary microadenoma was confirmed. Then the patient received chemotherapy combined with immunotherapy. But serum β-HCG level was still above the normal, and unfortunately, the patient died 6 months after his diagnosis. This case inspires us to think of the possibility of choriocarcinoma when a man presents gynecomastia or lung metastatic symptoms, adding Opdivo to the chemotherapy might not improve the poor treatment outcomes.
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Affiliation(s)
- Dong Liu
- Department of Gynaecology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qingjian Ye
- Department of Gynaecology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minjuan Ye
- Department of Gynaecology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuebo Yang
- Department of Gynaecology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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8
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Huang TH, Hung GY, Weng TF, Wang FM, Lee CY, Lin DT, Chen BW, Lin KH, Wu KH, Liu HC, Chen JS, Jou ST, Hou JY, Yang YL, Chen SH, Chang HH, Chiou SS, Lin PC, Chen RL, Hsiao CC, Yen HJ, Yang CP, Chang TK, Lu MY, Cheng CN, Sheen JM, Liao YM, Su MY, Yeh TC. Surgical treatment confers prognostic significance in pediatric malignant mediastinal germ cell tumors. Cancer 2022; 128:4139-4149. [PMID: 36223226 DOI: 10.1002/cncr.34494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/22/2022] [Accepted: 08/29/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Primary malignant mediastinal germ cell tumors (GCTs) are rare pediatric tumors that have a poorer prognosis compared to GCTs occurring elsewhere in the body. The current study aimed to assess the prognostic factors and treatment outcomes of children with primary malignant mediastinal GCT in Taiwan. METHODS The authors retrospectively reviewed children 0-18 years old who were newly diagnosed with primary malignant mediastinal GCT between January 1, 2005 and December 31, 2019 and were registered in the Taiwan Pediatric Oncology Group patient registry. The impact of presenting characteristics, including sex, age, tumor stage, histology subtype, surgical treatment, and chemotherapy regimens of the patients were analyzed. RESULTS This study enrolled 52 children with malignant mediastinal GCT who had a median age of 16.0 (range, 6.0-17.9) years at diagnosis. The most common histological subtypes were mixed GCTs (n = 20) and yolk sac tumors (n = 15). Advanced disease stage and choriocarcinoma histology subtype were associated inferior outcomes. Children who received surgical treatment exhibited better outcomes compared to those who did not (5-year overall survival, 78% vs. 7%, p < .001). After comparing patients who received first-line cisplatin- and carboplatin-based chemotherapy, no difference in treatment outcomes was observed. Multivariate analysis showed that surgical management was the only independent predictor for superior OS. CONCLUSIONS Surgical treatment is recommended for mediastinal GCT. Cisplatin-based chemotherapy was not superior to carboplatin-based chemotherapy as first-line treatment and may be avoided due to toxicity concerns.
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Affiliation(s)
- Ting-Huan Huang
- Division of Pediatric Hematology/Oncology, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Giun-Yi Hung
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Te-Fu Weng
- Division of Pediatric Hematology/Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Fu-Mien Wang
- Division of Pediatric Hematology/Oncology, Tri-Service General Hospital, Taipei, Taiwan
| | - Chih-Ying Lee
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Dong-Tsamn Lin
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Bow-Wen Chen
- Department of Pediatrics, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Kai-Hsin Lin
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Kang-Hsi Wu
- Division of Pediatric Hematology/Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hsi-Che Liu
- Division of Pediatric Hematology/Oncology and Mackay Medical College, MacKay Children's Hospital, Taipei, Taiwan
| | - Jiann-Shiuh Chen
- Division of Pediatric Hematology/Oncology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shiann-Tarng Jou
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Jen-Yin Hou
- Division of Pediatric Hematology/Oncology and Mackay Medical College, MacKay Children's Hospital, Taipei, Taiwan
| | - Yung-Li Yang
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Shih-Hsiang Chen
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiu-Hao Chang
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Shyh-Shin Chiou
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Chin Lin
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Rong-Long Chen
- Department of Pediatrics, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chih-Cheng Hsiao
- Division of Pediatric Hematology/Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hsiu-Ju Yen
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Chao-Ping Yang
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Te-Kau Chang
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | - Meng-Yao Lu
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Chao-Neng Cheng
- Division of Pediatric Hematology/Oncology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jiunn-Ming Sheen
- Division of Pediatric Hematology/Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Mei Liao
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Min-Yu Su
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | - Ting-Chi Yeh
- Division of Pediatric Hematology/Oncology and Mackay Medical College, MacKay Children's Hospital, Taipei, Taiwan
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Koilpillai S, Sun TY, Kropf J, Madruga M, Mohammed SY, Carlan SJ. A 24-Year-Old Man Presenting with Lung Metastases from a Primary Retroperitoneal Extragonadal Choriocarcinoma. AMERICAN JOURNAL OF CASE REPORTS 2022; 23:e936288. [PMID: 35927927 PMCID: PMC9361777 DOI: 10.12659/ajcr.936288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/24/2022] [Accepted: 06/12/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary retroperitoneal choriocarcinoma is a rare form of extragonadal germ cell tumor that is highly aggressive and responds poorly to chemoradiation. Extragonadal choriocarcinomas are notoriously challenging to diagnose, and have often progressed to advanced disease by the time of diagnosis. The survival rate for extragonadal choriocarcinoma is approximately 30%, which is much lower than that of extragonadal non-seminomatous germ cell tumors (GCT) in general. CASE REPORT A 24-year-old man with no significant past medical history presented with left-sided, pleuritic chest pain and back pain radiating down his left leg, of 1-year duration. Computed tomography (CT) of the chest revealed multiple bilateral pulmonary nodules and a CT of the abdomen and pelvis showed a large heterogeneous soft tissue mass measuring 9.3×8×10.5 cm. A CT-guided core needle biopsy of a lung nodule was performed and the findings were consistent with the diagnosis of metastatic choriocarcinoma. Magnetic resonance imaging (MRI) of the brain was negative for metastatic disease. Tumor markers were significant for a markedly elevated beta human chorionic gonadotropin (B-hCG) of 104 712 mIU/mL. He was diagnosed with a stage IIIC germ cell tumor, further classified as a primary retroperitoneal choriocarcinoma with lung metastasis, and was started on urgent inpatient chemotherapy. CONCLUSIONS Due to the poor outcomes associated with extragonadal choriocarcinoma, it is important to promptly and correctly identify this malignancy in order to initiate treatment in a timely manner. The following case report explores the histopathologic characterization of this malignancy and describes the clinical course and outcomes from treatment for this patient.
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Affiliation(s)
- Sarina Koilpillai
- Department of Internal Medicine, Orlando Regional Healthcare, Orlando, FL, USA
| | - Thomas Y. Sun
- Department of Internal Medicine, Orlando Regional Healthcare, Orlando, FL, USA
| | - Jacqueline Kropf
- Department of Internal Medicine, Orlando Regional Healthcare, Orlando, FL, USA
| | - Mario Madruga
- Department of Internal Medicine, Orlando Regional Healthcare, Orlando, FL, USA
| | | | - Steven J. Carlan
- Division of Academic Affairs and Research, Orlando Regional Healthcare, Orlando, FL, USA
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10
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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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11
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Ji YS, Park SH. Clinical Experience of Male Primary Choriocarcinoma at the Samsung Medical Center. Cancer Res Treat 2021; 53:874-880. [PMID: 33285049 PMCID: PMC8291190 DOI: 10.4143/crt.2020.1066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/05/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The objective of this study was to describe and analyze the clinicopathological features of primary choriocarcinoma (PCC) observed in male patients treated at the Samsung Medical Center between 1996 and 2020. MATERIALS AND METHODS We reviewed the clinical records of 14 male patients with PCC retrospectively to assess their demographic, histological, and clinical characteristics at the time of diagnosis as well as identify the treatment outcomes. RESULTS The median age of the patients was 33 years. The primary tumor site was the testicles in seven cases (50%), the mediastinum in six cases (43%), and the brain in one case (7%). The most common metastatic site was the lungs (79%), followed by the brain (43%). All patients with PCC received cytotoxic chemotherapy. Twelve patients had records of their response to cytotoxic chemotherapy; of these 12 patients, eight (8/12, 67%) achieved an objective response, and four (4/12, 33%) achieved stable disease response as the best response during chemotherapy. CONCLUSION It is known that most male PCC patients eventually develop resistance to cytotoxic chemotherapy and die. Factors such as poor response to chemotherapy, high disease burden, brain metastasis, and hemoptysis at the time of diagnosis are associated with shorter survival time in male PCC patients. Programmed death-1/programmed death-ligand 1 blockade therapy can be a salvage treatment for chemotherapy-resistant male PCC patients.
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Affiliation(s)
- Young Sok Ji
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Li H, Cai Z, Liu R, Hu J, Chen J, Zu X. Clinicopathological characteristics and survival outcomes for testicular choriocarcinoma: a population-based study. Transl Androl Urol 2021; 10:408-416. [PMID: 33532328 PMCID: PMC7844494 DOI: 10.21037/tau-20-1061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Due to the scarcity of cases of testicular choriocarcinoma (CC), its clinicopathological characteristics and prognosis have not been well summarized. Consequently, we conducted this population-based case-control study to characterize the features of testicular CC. Methods The SEER database was used to extract qualified data. Dichotomous variables were compared by Pearson’s Chi-squared or Fisher exact test. Survival variables were compared by Kaplan-Meier analyses and log-rank tests. The univariable and multivariable Cox regression analyses were applied to figure out risk factors for overall survival (OS) and cancer-specific survival (CSS). Propensity score matching (PSM) was used to control confounding factors in the study. Results In total, 788 patients with CC and 19,571 patients with seminoma were identified. Significant differences were found between two groups in terms of age (≤30 years: 65.4% vs. 26.5%; >30 years: 34.6% vs. 73.5%; P<0.001), marital status (28.8% vs. 52.1%; P<0.001), laterality (proportion of bilateral tumors: 4.1% vs. 1.0%, P<0.001), tumors size (≤4 cm: 40.2% vs. 49.3%; >4 cm: 45.8% vs. 43.0%; P<0.001), SEER stage (localized: 43.9% vs. 79.1%; regional: 14.6% vs. 15.4%; distant: 41.0% vs. 4.7%; P<0.001), surgery (92.4% vs. 98.2%; P<0.001) and chemotherapy (65.4% vs. 19.8%; P<0.001). However, no differences were found between two groups after Propensity Score Matching (PSM). Furthermore, CC had worse outcomes than seminoma in terms of 5-year rate of OS (85.5% vs. 97.3%) and 5-year rate of CSS (86.8% vs. 98.6%). In univariable Cox hazard model, age, laterality, SEER stage (distant), surgery, chemotherapy and pathological type were independent prognostic factors for OS and CSS. However, in multivariable Cox hazard model, only age, SEER stage(distant) and surgery remained as the independent prognostic factor for OS and CSS. Conclusions Choriocarcinoma is exceedingly rare disease with metastases at initial diagnose and has poor survival even after treatment. Old age and advanced tumor stage indicate a poor prognosis, while surgery therapy can improve prognosis. Nevertheless, longer-term studies with larger population of patients are needed to verify their biological behavior and therapeutic efficacy.
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Affiliation(s)
- Huihuang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiyong Cai
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Renyu Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Jiao Hu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiongbing Zu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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Yin S, Qin J, Zhou Q, Zhu C, Li Y, Wu D, Shen Z, Guo Y, Zhou Y, Nashan B. Sequential metastasis to the liver and pancreas 4 years after gestational trophoblastic neoplasia: a case report. J Int Med Res 2020; 48:300060520966807. [PMID: 33131363 PMCID: PMC7653300 DOI: 10.1177/0300060520966807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/21/2020] [Indexed: 11/15/2022] Open
Abstract
This case report describes a 43-year-old female initially diagnosed with gestational trophoblastic neoplasia that then experienced metastasis to the liver and then subsequently to the pancreas nearly 4 years after the primary diagnosis. After resection of the body and tail of the pancreas, the postoperative histopathological examination confirmed a placental site trophoblastic tumour that had developed after several cycles of chemotherapy for the original primary tumour and the liver metastases. This type of sequential recurrence of gestational trophoblastic neoplasia in the primary site or metastatic sites, such as the liver or pancreas, can be cured by a comprehensive treatment strategy involving surgery and/or salvage chemotherapy and continuous follow-up over a long period, especially for patients with a high-risk status.
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Affiliation(s)
- Shuai Yin
- Department of Hepatobiliary and Transplantation Surgery, The
First Affiliated Hospital of USTC, Division of Life Sciences and Medicine,
University of Science and Technology of China, Hefei, Anhui Province,
China
- Laboratory of Transplantation Immunology, University of Science
and Technology of China, Hefei, Anhui Province, China
| | - Jiwei Qin
- Department of Hepatobiliary and Transplantation Surgery, The
First Affiliated Hospital of USTC, Division of Life Sciences and Medicine,
University of Science and Technology of China, Hefei, Anhui Province,
China
- Laboratory of Transplantation Immunology, University of Science
and Technology of China, Hefei, Anhui Province, China
| | - Qingqing Zhou
- Department of Obstetrics and Gynaecology, Anhui Medical
University, Anhui Provincial Hospital, Hefei, Anhui Province, China
| | - Chenchen Zhu
- Department of Obstetrics and Gynaecology, Anhui Medical
University, Anhui Provincial Hospital, Hefei, Anhui Province, China
| | - Yuebo Li
- Department of Obstetrics and Gynaecology, The First Affiliated
Hospital of USTC, Division of Life Sciences and Medicine, University of Science
and Technology of China, Hefei, Anhui Province, China
| | - Dabao Wu
- Department of Obstetrics and Gynaecology, The First Affiliated
Hospital of USTC, Division of Life Sciences and Medicine, University of Science
and Technology of China, Hefei, Anhui Province, China
| | - Zhen Shen
- Department of Obstetrics and Gynaecology, The First Affiliated
Hospital of USTC, Division of Life Sciences and Medicine, University of Science
and Technology of China, Hefei, Anhui Province, China
| | - Yafei Guo
- Department of Hepatobiliary and Transplantation Surgery, The
First Affiliated Hospital of USTC, Division of Life Sciences and Medicine,
University of Science and Technology of China, Hefei, Anhui Province,
China
- Laboratory of Transplantation Immunology, University of Science
and Technology of China, Hefei, Anhui Province, China
| | - Ying Zhou
- Department of Obstetrics and Gynaecology, The First Affiliated
Hospital of USTC, Division of Life Sciences and Medicine, University of Science
and Technology of China, Hefei, Anhui Province, China
| | - Björn Nashan
- Department of Hepatobiliary and Transplantation Surgery, The
First Affiliated Hospital of USTC, Division of Life Sciences and Medicine,
University of Science and Technology of China, Hefei, Anhui Province,
China
- Laboratory of Transplantation Immunology, University of Science
and Technology of China, Hefei, Anhui Province, China
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Han C, Zhou Y, Ma JA, Liu J, Jiang YN, Zhang HX. A promising treatment option for refractory male primary choriocarcinoma: report of two cases. Transl Cancer Res 2020; 9:3054-3060. [PMID: 35117666 PMCID: PMC8799262 DOI: 10.21037/tcr.2020.02.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/18/2020] [Indexed: 12/26/2022]
Abstract
Male primary choriocarcinoma is a rare and invasive malignant neoplasm for which traditional chemotherapy has limited efficacy. Pembrolizumab is a humanized monoclonal anti-programmed death-1 antibody that has antitumor activity in numerous malignancies. The diagnosis and treatment of two cases of advanced male primary choriocarcinoma were retrospectively analyzed and relevant literature was reviewed to discuss the prognosis and the efficacy of different treatments, including pembrolizumab. The first patient, who presented with cough and hemoptysis, was diagnosed with primary mediastinal choriocarcinoma. He initially responded to the first-line chemotherapy of etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine, but eventually developed brain metastases. The patient did not respond to the second-line chemotherapy comprising paclitaxel and cisplatin, and he died 6.5 months after diagnosis. The second patient experienced repeated episodes of abdominal pain and was diagnosed with primary neck choriocarcinoma. He received chemotherapy regimens similar to those of the first patient. However, imaging showed no significant changes and his clinical symptoms were not improved. Immunohistochemistry showed that the expression of programmed death ligand 1 on the tumor cells was 40%, and he was administered pembrolizumab combined with chemotherapy. He achieved complete response and was subsequently switched to pembrolizumab maintenance monotherapy. He is still alive without evidence of disease 36 months after diagnosis. To our knowledge, this is the first case of advanced male primary choriocarcinoma successfully treated with pembrolizumab combined with chemotherapy. Advanced male primary choriocarcinoma is highly aggressive and insensitive to chemotherapy. Pembrolizumab may provide a promising treatment option to improve patient outcomes.
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Affiliation(s)
- Chen Han
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Ying Zhou
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Jin-An Ma
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Jia Liu
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Yu-Na Jiang
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Hai-Xia Zhang
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
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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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The Clinical Significance of a Small Component of Choriocarcinoma in Testicular Mixed Germ Cell Tumor (MGCT). Am J Surg Pathol 2019; 42:1113-1120. [PMID: 29794869 DOI: 10.1097/pas.0000000000001088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The clinical significance of limited choriocarcinoma in a malignant mixed germ cell tumor (MGCT) is unknown. Men with a MGCT with ≤5% choriocarcinoma at radical orchiectomy (RO) between 2000 and 2016 from our consult service were studied. Of 50 men in our cohort, we had clinical information for 30 men. Median follow-up was 41 months (1 to 168 mo). Median tumor size was 4.5 cm (1.1 to 8.0 cm). In total, 22/30 (73%) cases were pT1, 6/30(20%) cases were pT2, and 2/30 (7%) cases were pT3. In total, 4/30(13%) cases had lymph node metastases and 2/30 (7%) cases had distant metastases at the time of RO. In 30 cases with RO we had information on immediate postorchiectomy treatment: 14/30 (46.7%) active surveillance, 4/30 (13.3%) retroperitoneal lymph node dissection, 10/30 (33.3%) chemotherapy (chemotherapy), 1/30 (3.3%) retroperitoneal lymph node dissection followed by chemotherapy, and 1/30 (3.3%) resection of a distant metastasis. Preoperative serum human chorionic gonadotropin (hCG) levels ranged between 0.1 and 60,715 mIU/mL (mean, 4796; median, 485). One patient had an hCG level of 6367 mIU/mL and another 60,715 mIU/mL with the remaining cases <5000 mIU/mL. In total, 4/30 (13%) patients had elevated serum markers after surgery, 3 of them normalized following chemotherapy while the fourth one continued to have elevated serum alpha fetoprotein levels after chemotherapy. All patients were alive at last follow-up. In total, 7/30 (23.3%) patients subsequently developed metastatic disease to lymph nodes or distal organs, the histology of the metastasis consisted mainly of teratoma and yolk sac tumor. Embryonal carcinoma was present in 2 metastatic sites. One lung metastasis was suggestive for choriocarcinoma. Definitive choriocarcinoma was not present in any of the metastasis. A small component of choriocarcinoma in a MGCT is typically associated with relatively low-level elevations of serum hCG levels, and is not associated with aggressive disease. The presence of limited choriocarcinoma (≤5%) does not add to the prognostic information provided by standard TNM staging, which uses levels of serum markers (hCG, alpha fetoprotein, lactate dehydrogenase) as surrogates for extent of disease.
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Abstract
RATIONALE Choriocarcinoma is a rare and highly invasive gestational trophoblastic tumor that secretes high levels of human chorionic gonadotropin (hCG). As one of the uncommon non-gestational choriocarcinoma, primary mediastinal choriocarcinoma is an exceeding rare, and aggressive malignancy with poor prognosis. PATIENT CONCERNS A 26-year-old man was admitted to the hospital with cough, shortness of breath, and occasional hemoptysis. DIAGNOSES AND INTERVENTION Imaging examinations revealed a large mediastinal mass, diffuse nodular opacities with blurred edges in both lungs, and multiple brain lesions. Laboratory tests showed an astonishing increase of serum β-hCG. A diagnosis of primary mediastinal choriocarcinoma with advanced lung and brain metastases was finally made after 3 biopsies and immunohistochemical analyses. Surgery and radiotherapy were not applicable at the time of diagnosis, and both targeted therapy and immunotherapy were unavailable. During the first 4 cycles of trophoblastic tumor-based chemotherapy, the patient improved clinically with fewer symptoms, decreased β-hCG and reduced lesions. However, drug resistance quickly emerged, forcing an alternative chemotherapy regimen that also failed. OUTCOMES The patient finally endured symptoms including headache, dizziness and vomiting, and subsequently succumbed after an overall survival time of six and half months. LESSONS Male primary choriocarcinoma is an extremely rare type of malignancy. Greater awareness, earlier diagnosis and novel treatments are urgently needed to benefit patients.
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18
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Yen CJ, Yen CC, Tsai HW. Postmolar metastatic choriocarcinoma mimicking primary lung cancer. JOURNAL OF CANCER RESEARCH AND PRACTICE 2019. [DOI: 10.4103/jcrp.jcrp_7_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Qiu J, Jia S, Li G. Incidence and prognosis factors of extragonadal choriocarcinoma in males: a population-based study. Cancer Manag Res 2018; 10:4565-4573. [PMID: 30410393 PMCID: PMC6197831 DOI: 10.2147/cmar.s175948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Choriocarcinoma usually occurs in females and sometimes occurs in the testicles of males. Extragonadal choriocarcinoma in males was previously described in case reports, and our understanding of this type of cancer has remained limited. The purpose of this study was to explore the incidence, treatment and prognostic factors of extragonadal choriocarcinoma in males. Materials and methods Two cohorts were identified from the Surveillance, Epidemiology, and End Results (SEER) Program by histology, tumor site and sex. One cohort of 115 patients was created using the SEER nine registries (1973–2014) to estimate the incidence. The other cohort of 197 patients was created using the SEER 18 registries (1973–2013) to estimate the patient demographics and survival. Results The median age at diagnosis was 30 years. The most common primary tumor location was the mediastinum followed by the retroperitoneum and the brain. Approximately 23% of patients underwent beam radiation therapy, whereas 63.5% underwent surgery. The estimated one- and 5-year cause-specific survival rates were 49% and 35%, respectively. The multivariate analysis showed that the age at diagnosis, ie, a younger age of 0–19 years old, and the primary tumor site, ie, the brain, were the independent prognostic factors and were correlated with a favorable prognosis. The median survival time of patients was 186 months, 13 months and 4 months in the 0–19, 20–49 and 50+ years of age, respectively. Conclusion Extragonadal choriocarcinoma in males is a rare malignancy with a poor prognosis. A young age at diagnosis and primary tumor site in the brain were the independent prognostic factors.
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Affiliation(s)
- Jingping Qiu
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China,
| | - Shi Jia
- 7th General Surgery Unit, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guang Li
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China,
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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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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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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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