Primary pure choriocarcinoma of the liver

Hepatoid adenocarcinoma of the stomach with metastatic choriocarcinoma of the liver: A case report of a rare subtype of gastric cancer with a complex treatment course

Gastric hepatoid adenocarcinoma and hepatic choriocarcinoma are rare diseases in clinical settings, and the case we report here is a combination of both. A 66-year-old woman presented with a chief complaint of abdominal discomfort. The patient was examined using gastroscopy and computed tomography (CT) scan, and these revealed an irregular surface ulcer on the wall of the gastric antrum. A mass, 2.0 cm in diameter, was found in the liver in April 2020. The endoscopic biopsy findings were consistent with a diagnosis of moderately to poorly differentiated hepatoid adenocarcinoma. She was then referred to our hospital for further treatment. Initially, neoadjuvant therapy was initiated for the patient. The CT scan showed that the liver metastases had progressed; hence, surgery was performed. Postoperative pathology showed that the gastric lesions were mostly hepatoid adenocarcinoma with no choriocarcinoma, while the liver lesions comprised approximately 10% hepatoid adenocarcinoma and 90% choriocarcinoma. One month later, the patient developed tumor recurrence in the liver as observed on CT imaging. Subsequently, a variety of chemotherapy regimens were tried with no obvious results. The patient eventually developed multiple organ metastasis and died in July 2021. The overall survival was 16 months. Based on findings from this case report, it appears that initial neoadjuvant therapy was not effective and radical surgery may be the best treatment for patients with hepatoid adenocarcinoma of the stomach.

[Primary choriocarcinoma of the liver in a 36-year-old male patient. A case report and literature review]

The article presents a case of primary liver choriocarcinoma in a 36-year-old man. The patient was admitted to the hospital with signs of rapidly developing multiple organ failure, in connection with which the diagnosis was verified at autopsy according to histological and immunohistochemical studies. Diagnostic criteria and treatment options for this disease are insufficiently developed due to its rarity. To date, 11 clinical cases of primary choriocarcinoma of the liver in males have been described in the international literature. The article presents a review of the literature, as well as describes all published clinical observations of the disease.

Primary hepatic mixed germ cell tumor in an adult

Primary hepatic mixed germ cell tumor (GCT) is very rare, and less than 10 cases have been reported. We report a case of mixed GCT composed of a choriocarcinoma and yolk sac tumor, which occurred in the liver of a 40-year-old woman. A large mass was detected by computed tomography solely in the liver. Serum β-human chorionic gonadotropin (hCG) was highly elevated, otherwise, other serum tumor markers were slightly elevated or within normal limits. For hepatic choriocarcinoma, neoadjuvant chemotherapy was administered, followed by right lobectomy. Histologic features of the resected tumor revealed characteristic choriocarcinoma features with diffuse positivity for hCG in the syncytiotrophoblasts and diffuse positivity for α-fetoprotein and Sal-like protein 4 in the yolk sac tumor components. Primary malignant GCT in the liver is associated with a poor prognosis and requires specific treatment. Therefore, GCT should be considered during a differential diagnosis of a rapidly growing mass in the liver.

Multidisciplinary approach for treatment of primary hepatic choriocarcinoma in adult male patient

Choriocarcinoma is a rare malignant germ cell tumor and it usually occurs in the gonads (ovary or testis) and uterus. Primary hepatic choriocarcinoma (PHC) is a variant of choriocarcinoma featuring sole liver presentation without any evidence of gonodal involvements. Adult male patients with PHC carry dismal prognosis and their median survival period was less than 5 months. We herein present a first Korean case of a 54-year-old male patient with adult PHC, who was treated by surgical resection and chemotherapy through a multidisciplinary approach.

Primary choriocarcinoma of the liver: a rare, but important differential diagnosis of liver lesions

The case of a 64-year-old man with spontaneous acute abdominal bleeding is presented. Under suspicion of an atypical hepatocellular carcinoma an extended left hemihepatectomy was performed. Histological diagnosis after surgical therapy revealed a primary hepatic choriocarcinoma. During follow-up within 5 months several metastases were detected. Because of the number and localization of the metastases, there was no further curative surgical option and palliative systemic chemotherapy was initiated. Primary choriocarcinoma of the liver is an important differential-diagnosis in hypervascularized lesions of the liver. This tumor-entity is highly aggressive, with rapid tendency for metastatic spreading. This correlates with the poor prognosis of 12 months after tumor-detection.

Primary hepatic choriocarcinoma in a 49-year-old man: Report of a case

We report a case of hepatic choriocarcinoma in a man diagnosed at autopsy after a rapid downhill clinical course. The patient was a 49-year-old man who presented with acute right-sided abdominal pain. There were no masses palpable on physical examination. Radiographic findings showed large multi-nodular tumors mainly in the right lobe of the liver. Fludeoxyglucose-positron emission tomography scan showed uptake only in the liver, and no uptake in the testes. We initially planned to perform a liver resection for the presumed diagnosis of intra-hepatic cholangiocarcinoma. However, the tumors grew rapidly and ruptured. Multiple lung metastases rapidly developed resulting in respiratory failure, preventing liver resection or even biopsy. He died 60 d after initial presentation with no pathological diagnosis. Postmortem studies included histopathological and immunohistological examinations which diagnosed a primary choriocarcinoma of the liver. Primary hepatic choriocarcinoma is very rare but should be considered in the differential diagnosis of a liver tumor in a middle aged man. Establishing this diagnosis may enable treatment of the choriocarcinoma. Liver biopsy and evaluation of serum human chorionic gonadotropin are recommended in these patients.

Primary choriocarcinoma of the liver: a clinicopathological study of five cases in males

Primary choriocarcinomas of the liver are rare. Previous reported cases were mostly in infants with only rare adult cases. Here, we presented five adult cases. The patients were all males, with an average age of 41.6 years (from 36 to 48 years). Clinical presentations included right upper abdominal pain or abdominal distension. All patients presented with a large hepatic mass on ultrasonography that measured 11 cm on average in the greatest diameter. Elevated serum human chorionic gonadotropin (HCG) levels were noted in all cases. At presentation, the tumor was confined to the liver in two patients and therefore surgically resected. The other three patients presented with extrahepatic metastases on imaging study and therefore only received chemotherapy. All five patients died from the tumor within 2 to 8 months. Autopsy was performed for all five cases. The autopsy confirmed that the choriocarcinoma was confined to the liver in two surgically resected cases. The other three patients had metastatic choriocarcinoma in the lung (two patients), peritoneum (one patient), adrenal glands (one patient), and brain (one patient). None of the patients had any evidence of a testicular tumor or scar after examination of the entirely submitted testes. No tumor was observed in central nervous system, mediastinum, or other organs other than described above. Grossly, the primary tumors were large, soft, hemorrhagic, and with foci of necrosis. Histologically, the tumors were composed of mononucleated trophoblastic cells with round nuclei, clear cytoplasm, and prominent nucleoli admixed with large, multinucleated syncytiotrophoblastic cells. Immunohistochemically, tumor cells were strongly positive for keratin, HCG, and focally positive for human placental lactogen. Ki-67 proliferation index was high (mean 75%) in the mononucleated trophoblastic cells. Our series is the largest one to document primary hepatic choriocarcinoma in adults. Although these tumors are rare, they behave in a very aggressive fashion.