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Machado I, Martínez La Piedra MDC, Martínez de Juan F, de Alcántara FM, Claramunt R, López-Guerrero JA, Marhuenda A, Melian M. Primary Rectal Tumor With Extensive Choriocarcinoma Differentiation in a Woman With Lung, Liver and Disseminated Peritoneal Disease: A Primary Rectal Adenocarcinoma With Extensive Choriocarcinoma Differentiation or Primary Rectal Choriocarcinoma? Int J Surg Pathol 2024; 32:976-981. [PMID: 37885271 DOI: 10.1177/10668969231204956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Primary rectal adenocarcinoma with extensive choriocarcinomatous differentiation is a rare neoplasm, with only sporadic cases reported worldwide. The prognosis is typically poor, and no standard therapy has been established for this tumor. We report a case of a 63-year-old woman who presented with lower abdominal and pelvic discomfort, as well as rectal bleeding. Endoscopy revealed a rectal tumor. She was diagnosed with primary rectal adenocarcinoma with extensive choriocarcinomatous differentiation, accompanied by liver metastasis and peritoneal carcinomatosis. The immunohistochemical profile demonstrated strong and diffuse positivity for keratin (AE1/AE3), beta-human chorionic gonadotropin (β-HCG), p53, MYC, p16, and Ki-67. Molecular analysis indicated mutations in KRAS, TP53, and PI3KCA. Despite the tumor's profile, the serum β-HCG level was not elevated. A chemotherapy regimen for metastatic colorectal adenocarcinoma was initiated, but there was a poor response, with rapid tumor progression. The patient survived for only 5 months postdiagnosis. We discuss the histopathological, immunohistochemical, and molecular findings, emphasizing their relevance to the differential diagnosis of neoplasms with choriocarcinomatous differentiation.
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Affiliation(s)
- Isidro Machado
- Pathology Department, Instituto Valenciano de Oncología, Valencia, Spain
- Pathology Department, Patologika Laboratory, Hospital QuironSalud, Valencia, Spain
- Pathology Department, University of Valencia, Valencia, Spain
- Cancer CIBER (CIBERONC), Madrid, Spain
| | | | | | | | - Reyes Claramunt
- Molecular Biology Laboratory, Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Ana Marhuenda
- Radiology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - Marcos Melian
- Oncology Department, Instituto Valenciano de Oncología, Valencia, Spain
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Zhong J, Yang L. Histologic transformation of rectal adenocarcinoma to choriocarcinoma after surgery and chemotherapy: A rare case report and review of the literature. Int J Surg Case Rep 2024; 117:109478. [PMID: 38458023 PMCID: PMC10943425 DOI: 10.1016/j.ijscr.2024.109478] [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: 12/17/2023] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Choriocarcinoma is a rapidly progressive, widely metastatic, β-human chorionic gonadotropin (β-hCG)-secreting malignant tumor originating from trophoblast cells. Most choriocarcinomas are pregnancy-related. Choriocarcinoma of nonpregnant origin is very rare. CASE PRESENTATION A 60-year-old woman underwent abdominopelvic resection (APR) for low rectal cancer in May 2020. Postoperative pathological findings showed a poorly differentiated adenocarcinoma. Because of a post-operative recurrence, then she underwent chemotherapy for rectal adenocarcinoma. In February 2021, imaging finding showed metastases in her liver, both lungs and pelvis. Surprisingly, the β-hCG level was significantly elevated. A transvaginal pelvic tumor biopsy was performed and the pathology report was presented after discussions: choriocarcinoma differentiated carcinoma was considered, with no adenocarcinoma component detected. Then the patient underwent chemotherapy regimens for choriocarcinoma, which were initially effective but quickly became resistant. The patient died 8 months after the diagnosis of adenocarcinoma of the rectum transformed into choriocarcinoma. CLINICAL DISCUSSION The dedifferentiation of adenocarcinoma to choriocarcinoma is rarely diagnosed and the disease is often overlooked, leading to delays in diagnosis and treatment, documenting cases and their clinical outcomes is important for future research and to improve patient prognosis. Perhaps genomic assessment using next-generation sequencing (NGS) technology could help in diagnosis and guide therapeutic strategies. CONCLUSION We report a very rare case of non-pregnant choriocarcinoma transformed from primary rectal adenocarcinoma. Awareness of secondary biopsies in special cases and genetic testing based on the dynamics of the disease should be raised in clinical practice to better develop precise treatment plans.
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Affiliation(s)
- Juan Zhong
- Department of Oncology, Hubei Province Women and Children Hospital, Wuhan, China
| | - Lei Yang
- Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, China; Department of Radiation Oncology & Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China.
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Boyce J, Tawagi K, Cole JT. Primary colon adenocarcinoma with choriocarcinoma differentiation: a case report and review of the literature. J Med Case Rep 2020; 14:220. [PMID: 33190644 PMCID: PMC7667771 DOI: 10.1186/s13256-020-02544-0] [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: 08/09/2020] [Accepted: 09/30/2020] [Indexed: 11/15/2022] Open
Abstract
Background Choriocarcinoma is an aggressive malignancy of trophoblastic tissue, typically of gestational etiology. Sporadic, nongestational cases are rarely found outside of the gonads. There are only 31 cases of primary choriocarcinoma of the colon reported in the literature. As a consequence of their rarity and aggressive nature, timely diagnosis and effective treatment have proved challenging, and prognosis is very poor. For that reason, we present a rare case with prolonged survival in the youngest reported patient . Case presentation A 26-year-old Caucasian woman presented with abdominal cramping and rectal and vaginal bleeding. Elevated serum human chorionic gonadotropin and an 8-cm right-sided mass seen on ultrasound suggested ectopic pregnancy. The patient was treated with methotrexate; however, her symptoms persisted, and her human chorionic gonadotropin levels continued to rise. Further workup showed a large mass of the sigmoid colon with multiple hepatic lesions suggestive of metastases. Preliminary pathology showed adenocarcinoma. Despite surgical resection and initiation of FOLFOX chemotherapy (folinic acid, fluorouracil, oxaliplatin), the patient had significant clinical deterioration, and her human chorionic gonadotropin increased exponentially. Further pathological review showed two distinct phenotypes: adenocarcinoma merging with choriocarcinoma. The result of evaluation of the metastatic lesions was also positive for choriocarcinoma. Treatment was promptly changed to a choriocarcinoma-targeting chemotherapy regimen of EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine), resulting in rapid and dramatic response. The patient had mild progression after 1 year and was switched back to FOLFOX with bevacizumab. After five cycles, scans showed further progression, and the patient was started on third-line therapy with FOLFIRI (folinic acid, fluorouracil, irinotecan) and bevacizumab. Eighteen months after her diagnosis, the patient was alive and maintaining an overall response. Conclusions Our patient achieved a marked response and prolonged survival. Although a comprehensive review of the literature showed that survival with these tumors has improved over the past 10 years, prognosis remains poor. Currently, there is no established algorithm for the management of these rare tumors, but both the literature and our patient’s case indicate that a choriocarcinoma-targeted regimen is critical for survival. Further evaluation of these rare tumors is warranted in order to identify pathological patterns that may help in the diagnosis, management, and survival of these malignancies.
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Affiliation(s)
- Jessica Boyce
- Legacy Emanuel Medical Center, 2801 North Gantenbein Avenue, Portland, OR, 97227, USA. .,Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, 70121, USA.
| | - Karine Tawagi
- Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
| | - John T Cole
- Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, 70121, USA
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Mitselou A, Varouktsi A, Papadatos SS, Balasi E, Lampri E, Katsanos K, Galani V. Unusual abscess masquerading as poorly differentiated adenocarcinoma of the colon showing characteristics of choriocarcinoma. Autops Case Rep 2020; 10:e2020145. [PMID: 33344291 PMCID: PMC7703162 DOI: 10.4322/acr.2020.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Extragonadal non-gestational choriocarcinoma (ENC) is an uncommon malignant tumor occasionally found in the gastrointestinal tract. ENC is characterized by a biphasic tumor growth with distinct areas of adenocarcinoma and choriocarcinoma differentiation. Primary choriocarcinoma of the colon is extremely rare, with only 21 cases reported in the literature. Most of the perforation of colorectal cancers occurs in the abdominal cavity, while abdominal wall abscess is rare; the psoas abscess associated with colon carcinoma is even less observed. Herein, we report the case of a 61-year-old female with poorly differentiated adenocarcinoma of the ascending colon and sigmoid, with choriocarcinomatous differentiation, masquerading a psoas abscess formation. Unfortunately, despite the aggressive therapy, the patient’s disease rapidly progressed, and she died within 2 months after the diagnosis. The typical morphological pattern, immunohistochemistry, and its correlation with serum β-human chorionic gonadotropin enabled a correct diagnosis.
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Affiliation(s)
- Antigony Mitselou
- University of Ioannina School of Health Sciences, Department of Forensic Medicine. Ioannina, Greece
| | - Anna Varouktsi
- Ippokratio Hospital, Department of Internal Medicine. Thessaloníki, Greece
| | - Stamatis S Papadatos
- National and Kapodistrian University of Athens, Medical School, 3rd Department of Internal Medicine. Athens, Greece
| | - Eugenia Balasi
- University of Ioannina School of Health Sciences, Department of Forensic Medicine. Ioannina, Greece
| | - Evangeli Lampri
- University of Ioannina, Cancer Biobank Center. Ioannina, Greece
| | - Konstantinos Katsanos
- University of Ioannina School of Health Sciences, Department of Internal Medicine, Division of Gastroenterology. Ioannina, Greece
| | - Vasiliki Galani
- University of Ioannina, School of Health Sciences, Department of Anatomy, Histology and Embryology. Ioannina, Greece
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Telli TA, Demircan NC, Alan O, Tuylu TB, Arikan R, Ercelep O, Atıcı AE, Ergelen R, Seven IE, Babacan NA, Kaya S, Dane F, Fulden Yumuk P. A rare case of primary rectal choriocarcinoma and review of the literature. J Oncol Pharm Pract 2019; 26:989-994. [PMID: 31547751 DOI: 10.1177/1078155219875510] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Primary choriocarcinoma of the colon is an extremely rare neoplasm which has a poor prognosis. Only 18 cases have been previously reported in English medical literature. Here we present a case of primary rectal choriocarcinoma with a good response to chemotherapy and review the literature on this uncommon tumor. CASE REPORT A 36-year-old woman presented with abdominal pain and vaginal bleeding. Abdominal magnetic resonance imaging revealed 6.9 × 5.3 × 6.4 cm hypervascular mass posterior to uterus very close to rectum. Beta-human chorionic gonadotropin (β-hCG) level was markedly elevated. Low anterior resection of the rectum with lymph node dissection and total abdominal hysterectomy with bilateral salpingo-oophorectomy were performed. Pathologic diagnosis was reported as colonic choriocarcinoma with a focal component of adenocarcinoma. Post-operative magnetic resonance imaging detected multiple metastatic lesions throughout the liver. The patient was treated with systemic chemotherapy using bleomycin, etoposide and cisplatin (BEP protocol). After three cycles, β-hCG level decreased to normal and magnetic resonance imaging showed regression of liver metastasis. However, the patient died of respiratory failure due to bleomycin toxicity and pneumonia accompanied by rapid disease progression. DISCUSSION This is an extremely rare case of primary rectal choriocarcinoma. Due to poor prognosis of the disease, it seems very important to start prompt treatment to improve patient's survival.
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Affiliation(s)
- Tugba A Telli
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Nazim C Demircan
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Ozkan Alan
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Tugba B Tuylu
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Rukiye Arikan
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Ozlem Ercelep
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Ali E Atıcı
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Rabia Ergelen
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ipek E Seven
- Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nalan A Babacan
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Serap Kaya
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Faysal Dane
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Perran Fulden Yumuk
- Division of Medical Oncology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
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6
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Oh SK, Kim HW, Kang DH, Choi CW, Choi YY, Lim HK, Goo JJ, Choi SY. Primary Adenocarcinoma with Focal Choriocarcinomatous Differentiation in the Sigmoid Colon. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 66:291-6. [PMID: 26586354 DOI: 10.4166/kjg.2015.66.5.291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Primary colorectal choriocarcinoma is a rare neoplasm. Only 19 cases have been reported worldwide, most of which involved adenocarcinomas. The prognosis is usually poor, and the standard therapy for this tumor has not been established. A 61-year-old woman presented with constipation and lower abdominal discomfort. She was diagnosed with primary adenocarcinoma with focal choriocarcinomatous differentiation in the sigmoid colon and liver metastasis. Because the serum beta-human chorionic gonadotropin level was not significantly elevated, and because only focal choriocarcinomatous differentiation was diagnosed, we selected the chemotherapy regimen that is used for the treatment of metastatic colorectal adenocarcinoma. The patient survived for 13 months after the initial diagnosis. This is the first case in Korea to assess the suppressive effects of the standard chemotherapy for colorectal adenocarcinoma against coexisting colorectal choriocarcinoma and adenocarcinoma.
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Affiliation(s)
- Sook Kyoung Oh
- Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dae Hwan Kang
- Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Cheol Woong Choi
- Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yu Yi Choi
- Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hong Kyu Lim
- Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ja Jun Goo
- Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung Yeol Choi
- Department of Internal Medicine, Wallace Memorial Baptist Hospital, Pusan, Korea
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7
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Te Julián M, Pizarro E, Peralta SM, Vidal OG, Casals S, Ballestar E. Gynecomastia as Unusual Presentation of Primary Choriocarcinoma of the Colon: A Case Report and Literature Review. AACE Clin Case Rep 2015. [DOI: 10.4158/ep14485.cr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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8
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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: 23] [Impact Index Per Article: 2.3] [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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9
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Jiang L, Wu JT, Peng X. Primary choriocarcinoma of the colon: a case report and review of the literature. World J Surg Oncol 2013; 11:23. [PMID: 23356395 PMCID: PMC3566947 DOI: 10.1186/1477-7819-11-23] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 12/24/2012] [Indexed: 12/13/2022] Open
Abstract
Choriocarcinoma usually arises in the uterus and gonads. Primary choriocarcinoma (PCC) in an extragenital organ is rare. When it occurs in the gastrointestinal tract, the stomach is the most common site. Only 12 cases of PCC of the colon have been reported in the world literature. Most cases were associated with adenocarcinoma. We report the case of a 36-year-old man with PCC of the colon and review the clinical characteristics of previously documented cases.
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Affiliation(s)
- Lun Jiang
- Department of Medical Imaging, Su Bei People's Hospital of JiangSu Province, Medical School of Yangzhou University, Yangzhou, Jiangsu Province, China
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10
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Harada M, Inoue T, Hamano K. Choriocarcinoma of the sigmoid colon: report of a case. Surg Today 2011; 42:93-6. [PMID: 22075658 DOI: 10.1007/s00595-011-0026-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 01/14/2011] [Indexed: 01/14/2023]
Abstract
We report a rare case of primary choriocarcinoma of the colon. A 58-year-old woman underwent Hartmann's procedure to remove a sigmoid colon tumor, and pathological examination confirmed choriocarcinoma that had originated from the colon. Radical surgery combined with chemotherapy gives the best chance of long-term survival.
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Affiliation(s)
- Mikihiko Harada
- Department of Surgery, Hikari Municipal Yamato General Hospital, 974 Iwata, Hikari, Yamaguchi 743-0192, Japan.
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11
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[Gastrointestinal adenocarcinomas with a choriocarcinomatous component: 2 cases and a review of 120 cases in the literature]. ACTA ACUST UNITED AC 2008; 31:854-7. [PMID: 18166865 DOI: 10.1016/s0399-8320(07)73977-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Gastrointestinal adenocarcinoma with a choriocarcinomatous component (GACC) is an extremely rare and highly malignant human chorionic gonadotrophin-producing neoplasm. The development of this tumour from dedifferentiation or trans-differentiation of adenocarcinomatous cells is the most likely mechanism. 102 of the 120 cases reviewed in the literature presented enough clinicopathological information to be analysed. This tumour can be purely choriocarcinomatous or associated with an adenocarcinoma as in half of the observations. It is usually found in the stomach although it may be found throughout the digestive tract. The diagnosis of GACC should only be retained after having clearly eliminated a metastasis from a choriocarcinoma in particular in the gonads. The prognosis is very poor in particular in the gastric forms of this disease, with death observed within 12 months following diagnosis in 2/3 of the patients. There is no treatment consensus, and it is decided on a case-by-case basis.
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12
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Jeong JH, Cho YB, Park CM, Yun HR, Lee WS, Suh YL, Yun SH, Lee WY, Chun HK. Adenocarcinoma of the Rectum with Choriocarcinomatous Differentiation - A case report -. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2007. [DOI: 10.3393/jksc.2007.23.4.274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jae Hong Jeong
- Department of Surgery, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Bum Cho
- Department of Surgery, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Min Park
- Department of Surgery, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
| | - Hae Ran Yun
- Department of Surgery, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
| | - Won-Suk Lee
- Department of Surgery, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon-Lim Suh
- Department of Pathology, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
| | - Ho-Kyung Chun
- Department of Surgery, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea
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13
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Verbeek W, Schulten HJ, Sperling M, Tiesmeier J, Stoop H, Dinjens W, Looijenga L, Wörmann B, Füzesi L, Donhuijsen K. Rectal adenocarcinoma with choriocarcinomatous differentiation: Clinical and genetic aspects. Hum Pathol 2004; 35:1427-30. [PMID: 15668903 DOI: 10.1016/j.humpath.2004.06.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Nongestational choriocarcinomas are rare tumors. In the gastrointestinal tract, they are characterized by a biphasic tumor growth with separated areas of adenocarcinomatous and choriocarcinomatous differentiation. We here report a case of a combined adenocarcinoma-choriocarcinoma of the rectum. The tumor showed an aggressive clinical behavior with metastasis to the liver and lungs. A transient partial remission was achieved after 4 cycles of cisplatinum, etoposide, and ifosfamide chemotherapy, with normalization of serum beta-human chorionic gonadotropin levels. At this time, viable residual choriocarcinoma cells were found in surgically resected lung metastasis. The patient succumbed 8 months after initial diagnosis to a rapid abdominal relapse. We used comparative genomic hybridization (CGH) and fluorescence in situ hybridization to elucidate the genetic relationship of adenocarcinoma and choriocarcinoma in this neoplasm. We found genetic changes characteristic for colorectal adenocarcinomas, a loss of chromosomal regions 8p21-pter as well as 18q21-pter, and a gain of 5p and 20q, in both tumor parts. This provides evidence for the common origin of both components. A differential pattern of additional genetic changes suggests a clonal evolution from a common ancestor cell. In contrast to findings from a comparative study on a choriocarcinoma of the renal pelvis, we did not find an amplification of the germ cell cancer-associated chromosomal region 12p11.2-p12.1 in the areas of choriocarcinoma but found instead a loss of Xp11.3-pter. To our knowledge, this is the first report of a CGH comparison of the adenocarcinomatous and choriocarcinomatous tumor parts in a nongestational choriocarcinoma of the gastrointestinal tract.
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Affiliation(s)
- W Verbeek
- Department of Internal Medicine III, Klinikum Braunschweig, Germany
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14
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Abstract
Most germ cell tumors occur in the gonads or in extragonadal sites in the anatomic midline; this article reviews tumors with similar or identical histologic features that arise in other topographic locations. Such lesions often represent the presence of "germ cell-like" or "germinal" components in what is otherwise recognized as a somatic neoplasm; however, they may also occur in pure form. The morphologic and immunohistochemical features of these proliferations are reviewed, according to the types of germ cell tumors that they recapitulate.
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Affiliation(s)
- J Carlos Manivel
- Division of Surgical Pathology, Department of Laboratory Medicine & Pathology, University of Minnesota School of Medicine, Minneapolis, MN 55455, USA.
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15
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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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Kiran RP, Visvanathan R, Simpson CG. Choriocarcinomatous metaplasia of a metachronous adenocarcinoma of the colon. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2001; 27:436-7. [PMID: 11417994 DOI: 10.1053/ejso.2000.1089] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A second primary colonic adenocarcinoma developed in a 68-year-old man following resection of a rectal adenocarcinoma. Choriocarcinomatous change was found in the metachronous lesion with liver metastases and elevated beta-human choriogonadotrophin (HCG) serum titres.
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Affiliation(s)
- R P Kiran
- Department of Surgery, Bronglais General Hospital, Aberystwyth SY23 1ER, UK
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17
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Petricek CM. Colonic adenocarcinoma metastasizing as a germ cell neoplasm: a case report and review of the literature. Arch Pathol Lab Med 2001; 125:558-61. [PMID: 11260638 DOI: 10.5858/2001-125-0558-camaag] [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] [Indexed: 11/06/2022]
Abstract
Mixed tumors of the gastrointestinal tract, including both adenocarcinoma and germ cell neoplasm, have been reported infrequently. In the colon, only 9 cases, to our knowledge, have been described in the English-language literature. This is the case of a 29-year-old man with an unsuspected mixed colonic neoplasm that metastasized as the germ cell component.
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Affiliation(s)
- C M Petricek
- Department of Pathology, University of Michigan Hospital, M5240 Medical Sciences I, 1301 Catherine Rd., Ann Arbor, MI 48109-0602, USA.
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18
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Jan YJ, Chen JT, Ho WL, Wu CC, Yeh DC. Primary coexistent adenocarcinoma and choriocarcinoma of the stomach. A case report and review of the literature. J Clin Gastroenterol 1997; 25:550-4. [PMID: 9412977 DOI: 10.1097/00004836-199710000-00016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report a case of primary gastric choriocarcinoma with liver metastasis. The mixed histologic patterns included adenocarcinoma, undifferentiated carcinoma, and choriocarcinoma. Immunohistologic staining for the beta-subunit of human chorionic gonadotrophin (beta-HCG) showed positive results in the choriocarcinoma, adenocarcinoma, and normal mucosal gland. However, positive HCG cells were present at different intensities in the choriocarcinoma, adenocarcinoma, and normal mucosal gland. The level of HCG was significantly increased in serum. This unusual tumor probably resulted from dedifferentiation of a primary adenocarcinoma or developed directly from the mucosal glands.
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Affiliation(s)
- Y J Jan
- Department of Pathology, Taichung Veterans General Hospital, Taiwan, Republic of China
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