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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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3
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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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4
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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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5
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Rodilla IG, Val-Bernal JF, Cabrera E, Fernández F. Primary Choriocarcinoma of the Rectum in a Man Case Report and Literature Review. Int J Surg Pathol 2016. [DOI: 10.1177/106689699510030207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A case of pure extragonadal choriocarcinoma in the rectum of an 84-year-old man is described. The patient complained of rectal bleeding and lower abdominal pain. The trophoblastic origin of the tumor was documented by immunoperoxidase staining for human chorionic gonadotropin. The DNA histogram showed a diploid pattern. The patient died 106 days after diagnosis. Only eight cases of choriocarcinoma of the large intestine have been reported, three of which were located in the rectum. The age of patients affected range widely, from 28 to 84 years with a mean of 54 years: 79 for males and 46 for females. Women are affected three times as often as men. The pathologic study showed adenocarcinoma with germ cell elements in seven cases: six choriocarcinoma and one mixed (choriocarcinoma and endodermal sinus tumor). Germ cell differentiation may be difficult to identify in small biopsy samples, which may not be representative of the tumor as a whole. The prognosis of patients with choriocarcinoma of the large bowel is very poor; survival is less than 5 months. Although choriocarcinoma in the rectum is very rare, it should be included in the differential diagnosis of rectal neoplasms.
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Affiliation(s)
- Irene G. Rodilla
- From the Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain
| | - J. Fernando Val-Bernal
- From the Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain
| | - Ernesto Cabrera
- From the Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain
| | - Fidel Fernández
- From the Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria, Santander, Spain
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6
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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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7
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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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8
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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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9
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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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10
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Wang L, Pitman MB, Castillo CFD, Dal Cin P, Oliva E. Choriocarcinoma involving the pancreas as first manifestation of a metastatic regressing mixed testicular germ cell tumor. Mod Pathol 2004; 17:1573-80. [PMID: 15545958 DOI: 10.1038/modpathol.3800226] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We describe an unusual case of metastatic choriocarcinoma of the pancreas arising from a regressing testicular mixed germ cell tumor that clinically mimicked a primary pancreatic tumor. A 54-year-old male presented with a 2-month history of progressive upper abdominal pain, weight loss, and jaundice. He also had a history of recurrent epididymitis associated with the presence of a right testicular mass shown to be cystic by ultrasound and stable for at least 10 years. A computed tomography scan showed an isolated 6 cm mass in the head of the pancreas. A pancreaticoduodenectomy was performed. Upon histological examination, the pancreatic tumor showed extensive hemorrhage and necrosis. In the viable area, the tumor was composed of an intimate mixture of mononuclear cytotrophoblast cells and multinucleated syncytiotrophoblasts with vascular invasion. These characteristic features led to the correct diagnosis on frozen section. The cytology of the tumor was nonspecific and suggested undifferentiated carcinoma of the pancreas. The trophoblastic origin of the tumor cells was confirmed by immunohistochemistry staining. The testicular mass showed a regressed mixed germ cell tumor of predominantly seminoma with focal teratoma but without a choriocarcinoma component. In conclusion, we present a rare and unusual case of a regressing testicular mixed germ cell tumor that presented as a primary pancreatic tumor. Cytological features of the pancreatic mass were not specific and raised the possibility of a primary undifferentiated carcinoma of the pancreas. Characteristic histological features of choriocarcinoma led to the correct diagnosis on frozen section. Subsequent resection of the testicular mass confirmed the presence of a cystic and scarring (regressing) mixed germ cell tumor but without evidence of choriocarcinoma.
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Affiliation(s)
- Lan Wang
- Department of Pathology, Harvard Medical School, Boston, MA 02114, USA
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11
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Coleman TA, Redger CD, Hamill RL, Dainer P. Rectal adenocarcinoma with germ-cell differentiation: report of a case. Dis Colon Rectum 2003; 46:1702-5. [PMID: 14668599 DOI: 10.1007/bf02660779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A 26-year-old male presented with a colorectal adenocarcinoma with germ-cell differentiation and an isolated elevation of serum alpha-fetoprotein. He was treated with platinum/etoposide/bleomycin chemotherapy with a decrease in serum alpha-fetoprotein and in the size of the primary tumor. An ongoing tumor-marker response occurred when the patient was switched to concurrent 5-fluorouracil chemotherapy and radiation therapy. The patient underwent a palliative diversion of his rectal cancer 10 months after diagnosis, developed liver metastasis at 12 months, and died 20 months after diagnosis.
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Affiliation(s)
- Teresa A Coleman
- Department of Medical Oncology, Eisenhower Army Medical Center, Augusta, Georgia, USA
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12
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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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13
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Campbell PA, McKendrick J. Choriocarcinoma of the urinary bladder. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1999; 69:533-7. [PMID: 10442930 DOI: 10.1046/j.1440-1622.1999.01607.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- P A Campbell
- Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia
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14
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Puglisi F, Damante G, Pizzolitto S, Mariuzzi L, Guerra S, Pellizzari L, Binotto F, Beltrami CA. Combined yolk sac tumor and adenocarcinoma in a gastric stump. Cancer 1999. [DOI: 10.1002/(sici)1097-0142(19990501)85:9%3c1910::aid-cncr5%3e3.0.co;2-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Puglisi F, Damante G, Pizzolitto S, Mariuzzi L, Guerra S, Pellizzari L, Binotto F, Beltrami CA. Combined yolk sac tumor and adenocarcinoma in a gastric stump. Cancer 1999. [DOI: 10.1002/(sici)1097-0142(19990501)85:9<1910::aid-cncr5>3.0.co;2-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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16
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Nogales FF, Bergeron C, Carvia RE, Alvaro T, Fulwood HR. Ovarian endometrioid tumors with yolk sac tumor component, an unusual form of ovarian neoplasm. Analysis of six cases. Am J Surg Pathol 1996; 20:1056-66. [PMID: 8764742 DOI: 10.1097/00000478-199609000-00003] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The clinical, morphological, and immunohistochemical findings in six cases of ovarian endometrioid tumors (five endometrioid carcinomas and one carcinosarcoma) with a yolk sac tumor (YST) component are described. The age of the patients ranged from 31 to 73 years (average, 53), and only two patients were premenopausal. Two cases were stage Ia tumors, three stage III, and one stage IV. A substantial postoperative elevation of alpha-fetoprotein (AFP) was seen in two patients and a mild increase in another two. All six patients had surgery and postoperative cisplatin-based chemotherapy regimens, four of whom died of tumor 3 to 14 months after surgery without response to treatment. Only a stage Ia patient is alive and well 1 year after surgery. The tumors were large (average, 17 cm). Benign endometrioid lesions were found in the homolateral ovary in two cases and in the contralateral ovary in another two. All cases had endometrioid ovarian carcinomas (EOC) of various types admixed with typical YST components. Immunohistochemically, EOC areas differed from YST in their positivity for OC 125, CA 19.9, and nuclear estrogen and progesterone receptors and in their negativity for AFP, which was conspicuously positive in the YST areas. The clinicopathological profile of ovarian endometrioid tumors with YST also differs from that of YST in that it occurs in the same age range as EOC, it shows coexistence of benign endometrioid lesions, and it has a poor response to chemotherapy. The histological pattern in transitional areas may be difficult to differentiate from "endometrioid-like" (enteroblastic) YST and clear cell tumors. Ovarian endometrioid tumors with YST component should be considered a variant of endometrial carcinoma. Its recognition is necessary in view of its unusually aggressive behavior and poor prognosis.
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Affiliation(s)
- F F Nogales
- Department of Pathology, University Hospital, Granada, Spain
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17
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Tokisue M, Yasutake K, Oya M, Nishisaki H, Nakashima T, Hasegawa H, Sakoda Y, Kizaki T, Sashikata T, Morita R. Coexistence of choriocarcinoma and adenocarcinoma in the rectum: molecular aspects. J Gastroenterol 1996; 31:431-6. [PMID: 8726837 DOI: 10.1007/bf02355035] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Choriocarcinoma, a malignant tumor of usually placental origin, in divided into two groups; the gestational and non-gestational types, the latter being rare. Non-gestational choriocarcinoma occurs in the lung, mediastinum, kidney, stomach, and small intestine, but rarely appears in the large intestine. We treated a 29-year-old woman with choriocarcinoma of the rectum with adenocarcinoma. Despite the rarity of the condition and the obscurity of the histogenesis, reports of similar cases and the occurrence of the tumors in the digestive tract suggest that the condition constitutes a clinical entity of a digestive tumor.
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Affiliation(s)
- M Tokisue
- Department of Gastroenterology, Hyogo Medical Center for Adults, Akashi, Japan
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18
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Abstract
BACKGROUND Ovarian carcinomas may produce human chorionic gonadotropin (HCG) or HCG-like substances and may even contain syncytiotrophoblast cells, but a true choriocarcinomatous component has not been described in these tumors. METHODS Two cases of poorly differentiated ovarian carcinoma with choriocarcinomatous components are reported. Pathologic findings were correlated with immunohistochemical stains, hormonal effects, and clinical behavior. RESULTS Each tumor contained a circumscribed, extensively necrotic and hemorrhagic brown nodule. Microscopically, the nodules exhibited a mixture of cytotrophoblast and syncytiotrophoblast. The syncytiotrophoblast capped cytotrophoblast and was strongly positive for beta-HCG. In one of the cases, a transformation zone composed of poorly differentiated carcinoma with occasional beta-HCG-positive cells was observed between a mucinous cystadenoma and the choriocarcinomatous elements. The two cases exhibited activation of the ovarian stroma in the form of condensation and luteinization. Extra-abdominal metastases developed early in both patients and, despite multiagent chemotherapy, they died shortly postoperatively. CONCLUSIONS Choriocarcinoma may rarely develop as a result of dedifferentiation of common epithelial ovarian tumors. Recognition of choriocarcinomatous components in ovarian carcinomas is important because of its association with aggressive behavior.
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Affiliation(s)
- E Oliva
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
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19
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Ostör AG, McNaughton WM, Fortune DW, Rischin D, Hillcoat BL, Riley CB. Rectal adenocarcinoma with germ cell elements treated with chemotherapy. Pathology 1993; 25:243-6. [PMID: 7505421 DOI: 10.3109/00313029309066581] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A patient with adenocarcinoma of the rectum containing germ cell elements in the form of endodermal sinus tumor and choriocarcinoma is described, believed to be the first such tumor reported in the literature. The serum levels of alpha-fetoprotein and human chorionic gonadotropin were markedly elevated. The source of the markers was localized to the neoplastic tissue by the immunoperoxidase technique. The patient developed extensive hepatic metastases thought to be due to choriocarcinoma for which she received chemotherapy. One wk after commencing treatment a massive fatal hepatic hemorrhage occurred.
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Affiliation(s)
- A G Ostör
- Department of Pathology, Royal Women's Hospital, Melbourne, Victoria
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20
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Nogales FF, Ruiz Avila I, Concha A, del Moral E. Immature endodermal teratoma of the ovary: embryologic correlations and immunohistochemistry. Hum Pathol 1993; 24:364-70. [PMID: 8491476 DOI: 10.1016/0046-8177(93)90083-s] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Two grade 2 ovarian immature, predominantly endodermal teratomas are reported. The teratomas were in stage I and occurred in two girls, 9 and 10 years of age, who were treated with triple chemotherapy. These neoplasms differed from the usual immature ovarian teratoma as they contained no neuroectodermal components and had high alpha-fetoprotein and low human chorionic gonadotropin levels as their serum markers despite the absence of other concomitant germ cell tumors. The epithelia of the teratomas demonstrated exclusively the embryologic development of endoderm, ranging from early endoderm to tissues similar to esophagus, liver, and intestinal structures. All epithelial derivatives were positive for alpha-fetoprotein and alpha 1-antitrypsin. Liver and esophagus expressed fibrinogen, while intestine and esophagus were positive not only for carcinoembryonic antigen and chromogranins but also for thyroglobulin, thus reflecting yet another type of endodermal differentiation into thyroid. Focal human chorionic gonadotropin positivity associated with primitive intestinal and esophageal epithelia may reflect the early embryologic relationships between endoderm and trophoblast. These cases demonstrate that simultaneous alpha-fetoprotein and human chorionic gonadotropin secretion may occur in immature teratoma. The mesenchymal component also showed a wide range of differentiation, from primitive mesoblastic cells to differentiated cells, such as hemopoietic foci, smooth muscle, bone, and cartilage. Both the primitive endoderm and the mesenchyme co-expressed vimentin and keratin, reflecting their intimate developmental relationships and possibly supporting the hypothesis of mesenchyme originating from endoderm, as suggested by previous embryologic studies. Since endodermal and mesenchymal areas similar to those described here are found in association with yolk sac tumors and embryonal carcinoma, it is possible that the present cases may represent an endodermal differentiation accomplished by either of these developmentally related germ cell tumors.
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Affiliation(s)
- F F Nogales
- Department of Pathology, University of Granada School of Medicine, Spain
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21
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Abstract
Three cases of poorly differentiated endometrial adenocarcinoma showing trophoblast-like differentiation are reported. The multinucleated, syncytiotrophoblast-like cells were strongly positive for beta-human chorionic gonadotropin (beta-HCG) by immunohistochemical study. High levels of beta-HCG were also present in the patients' serum, but dropped significantly after treatment. The patients had an unusually rapid and progressive clinical course with widespread dissemination and death by tumor.
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Affiliation(s)
- C Pesce
- Laboratory of Pathology, National Institutes of Health, Bethesda, Maryland 20892
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22
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Campo E, Algaba F, Palacin A, Germa R, Sole-Balcells FJ, Cardesa A. Placental proteins in high-grade urothelial neoplasms. An immunohistochemical study of human chorionic gonadotropin, human placental lactogen, and pregnancy-specific beta-1-glycoprotein. Cancer 1989; 63:2497-504. [PMID: 2655871 DOI: 10.1002/1097-0142(19890615)63:12<2497::aid-cncr2820631223>3.0.co;2-q] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We examined the presence of human chorionic gonadotropin (HCG) in 16 low-grade and 47 high-grade urothelial neoplasms, including two cases with trophoblastic-like differentiation. In HCG-positive tumors, the presence of human placental lactogen (HPL) and pregnancy-specific beta-1-glycoprotein (SP-1) also was assessed. HCG immunoreactive cells were found in nine of the 47 high-grade tumors (19%), whereas none of the low-grade tumors were positive for HCG. This hormone was predominantly detected in the most undifferentiated and pleomorphic areas; however, HCG-positive cells also were found in areas of carcinoma in situ and well-differentiated transitional cell carcinoma in two cases. The serum HCG level was increased in two of the four cases studied. HPL and SP-1 immunoreactive cells were observed in seven and five cases, respectively, and it was found that tumors positive for SP-1 also were positive for HPL. Five tumors, including the two with trophoblastic differentiation, contained the three placental proteins. The HPL and SP-1 immunostained cells were usually found in the same areas of the tumor that were positive for HCG, but there was always a lower number of HPL and SP-1 immunoreactive cells than HCG immunoreactive cells. In one case, HPL and SP-1 could be found in areas of well-differentiated transitional cell carcinoma. These findings suggest that the morphologic and functional trophoblastic differentiation in urothelial carcinomas is a progressive phenomenon evolving from transitional cell carcinomas.
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Affiliation(s)
- E Campo
- Department of Pathology, Hospital Clínico y Provincial de Barcelona, Spain
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23
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Sridhar KS, Saldana MJ, Thurer RJ, Beattie EJ. Primary choriocarcinoma of the lung: report of a case treated with intensive multimodality therapy and review of the literature. J Surg Oncol 1989; 41:93-7. [PMID: 2657222 DOI: 10.1002/jso.2930410208] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Primary choriocarcinomas of the lung are extremely rare. Like choriocarcinomas elsewhere, they possess rapid growth ability and a high propensity to metastasize. There is minimal information available on the treatment of lung choriocarcinoma. In the case reported herein, neoadjuvant chemotherapy with 5-fluorouracil (5-FU) infusion, etoposide, and cisplatin induced a partial response permitting complete excision of a massive tumor of the right upper lobe involving the chest wall and superior vena cava. The patient relapsed with a metastasis to the brain that was surgically excised. Contralateral lung metastases were soon noted and responded well to systemic chemotherapy; yet the patient died of a new brain metastasis. To our knowledge, this is the first example of a primary choriocarcinoma of the lung treated with intensive multimodality therapy. The latter seems to offer a potential benefit if certain guidelines are followed.
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Affiliation(s)
- K S Sridhar
- Pananicolaou Comprehensive Cancer Center, University of Miami School of Medicine, Jackson Memorial Hospital, Florida
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24
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Collins RJ, Wong LC. Adenocarcinoma of the uterine cervix with beta-hCG production: a case report and review of the literature. Gynecol Oncol 1989; 33:99-107. [PMID: 2467847 DOI: 10.1016/0090-8258(89)90612-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The production of unexpected cell products, including the placental protein human chorionic gonadotrophin (hCG), has been reported in a variety of tumors at different anatomical sites. Some of the reported tumors have also expressed morphological features suggesting choriocarcinoma. Such is the case in this tumor of the uterine cervix which has a major component of anaplastic tumour with beta-hCG production confirmed both by positive staining using immunoperoxidase techniques and by pre- and postoperative serum assays for beta-hCG. The differing immunohistochemical features seen in the two components of the tumor are reported. The relationship of the anaplastic component to the adjacent mucinous adenocarcinoma in the present case, and to similar cases at other sites from the literature, is discussed.
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Affiliation(s)
- R J Collins
- Department of Pathology, University of Hong Kong
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25
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Shousha S, Chappell R, Matthews J, Cooke T. Human chorionic gonadotrophin expression in colorectal adenocarcinoma. Dis Colon Rectum 1986; 29:558-60. [PMID: 3527610 DOI: 10.1007/bf02554253] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The presence of human chorionic gonadotrophin (HCG) in colorectal adenocarcinoma was studied histologically in 45 tumors using immunoperoxidase technique. Ten neoplasms (22.2 percent) contained HCG-positive tumor cells. These cells were present mostly at the periphery of the tumors. Many formed parts of glands, while some were arranged in syncytial clumps or columns, or singularly. Thus, these tumor cells resembled trophoblastic tissue not only in being HCG-positive but also in their peripheral distribution and occasionally in morphologic appearance. HCG-positive tumors were seen more commonly in the rectosigmoid region (90 percent) and were more aggressive than HCG-negative tumors. In this study, lymph node or liver metastases were present in 70 percent of HCG-positive tumors compared with 29 percent of negative tumors--a difference which is statistically significant.
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Abstract
A case is reported of primary gastric choriocarcinoma occurring in a 73-year-old man, associated with a high serum level of beta hCG. Both primary and lymph node metastases contained exclusively cyto and syncytiotrophoblastic elements. Immunohistochemical localization of chorionic gonadotropin (hCG), placental lactogen (hPL) and pregnancy-specific glycoprotein (SP 1) is described in relation to cytotrophoblastic differentiation. An intramucosal focus of adenocarcinoma supports the hypothesis of the origin of choriocarcinoma from usual gastric cancer.
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Hainsworth JD, Greco FA. Human chorionic gonadotropin production by colon carcinoma. Biochemical heterogeneity and identification of a chemotherapy-sensitive cell subpopulation. Cancer 1985; 56:1337-40. [PMID: 2411376 DOI: 10.1002/1097-0142(19850915)56:6<1337::aid-cncr2820560620>3.0.co;2-p] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Human chorionic gonadotropin (hCG) is produced and secreted by a wide variety of human neoplasms and represents one example of biochemical heterogeneity in tumors. The authors report two patients with advanced hCG-producing colon carcinomas in whom immunohistochemical staining demonstrated a distinct hCG-producing cell subpopulation. Both patients had objective tumor responses when treated with chemotherapy effective against germinal neoplasms. Responses were characterized by prompt and substantial reduction in plasma hCG levels and by improvement in clinical status, radiographic tumor measurements, and other biochemical abnormalities. These epithelial carcinomas responded to chemotherapeutic agents that are usually ineffective, and striking chemosensitivity was observed in the hCG-producing cell subpopulation. These two cases provide initial evidence that hCG-producing cells are sensitive to certain chemotherapeutic agents even when they are a part of common epithelial somatic tumors, and that this sensitivity represents another type of heterogeneity in human tumors. The identification of hCG production in epithelial tumors may be important in determining therapeutic strategy.
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28
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Metz KA, Richter HJ, Leder LD. Adenocarcinoma of the colon with syncytiotrophoblastic differentiation: differential diagnosis and implications. Pathol Res Pract 1985; 179:419-24. [PMID: 4039056 DOI: 10.1016/s0344-0338(85)80152-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A case of adenocarcinoma of the colon is reported, whose metastases exhibited a syncytiotrophoblastic differentiation that gradually increased with advancing distance from the primary. Immunohistochemically, syncytiotrophoblastic giant cells with strong positivity for beta-HCG could be demonstrated within the metastatic tissue. Also, there was beta-HCG positivity in a fraction of the atypical epithelial elements of the primary. The case is discussed with respect to the differential diagnosis, and the cause of the syncytiotrophoblastic differentiation is attributed to the phenomenon of genetic instability. The case shows that by virtue of genetic instability totally new differentiations may be elaborated, so that the phenotypical appearance of a given tumor does not necessarily allow conclusions as to its tissue of origin. Thus, observations such as the one presented here clearly indicate that the histogenetic principle of tumor classifications by far does not apply to all cancers and that, therefore, its value and validity are considerably limited.
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Abstract
A rare case of a colon carcinoma that developed in a 50-year-old woman is documented. Histologically, the removed tumor was composed of two distinctive elements, i.e., well-differentiated papillary adenocarcinoma and choriocarcinoma. It was strongly suggested that the latter malignancy derived from the pre-existing colonic carcinoma through metaplastic proliferation. A very high human chorionic gonadotropin level was noted in the patient's serum obtained at the preoperative stage. Autopsy materials revealed that metastatic foci in the liver, lungs, and lymph nodes were exclusively composed of choriocarcinoma.
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Wirt DP, Nagle RB, Gustafson HM, Philpott PJ, Kuivinen NA, Schuchardt M. The probable origin of an anemone cell tumor: metastatic transitional cell carcinoma producing HCG. Ultrastruct Pathol 1984; 7:277-88. [PMID: 6537094 DOI: 10.3109/01913128409141488] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A neoplasm of unknown origin in cervical and axillary lymph nodes was diagnosed as anemone cell tumor by ultrastructural examination. Three years after the initial diagnosis of anemone cell tumor, a high-grade transitional cell carcinoma of the bladder was discovered. The results of immunoperoxidase staining of the cervical lymph node, axillary lymph node, and bladder tumors for keratin, carcinoembryonic antigen, and human chorionic gonadotropin (HCG) strongly suggest that the anemone cell tumors in this case represent metastases of bladder carcinoma cells capable of producing HCG.
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