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Mosaffa SL, Eapen G, Kalhor N, Sneige N. Non-small cell lung carcinoma with ectopic gonadotropin production: A case report and review of the literature. Diagn Cytopathol 2024; 52:397-399. [PMID: 38576061 DOI: 10.1002/dc.25318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Sara L Mosaffa
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Georgie Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Neda Kalhor
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nour Sneige
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Xu J, Xu Y, Xu C, Wang C. Morphological and molecular pathological features of the breast carcinoma with choriocarcinomatous features: A case report and a literature review. Front Oncol 2023; 13:984425. [PMID: 36969041 PMCID: PMC10031012 DOI: 10.3389/fonc.2023.984425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
Here we present a rare case of breast cancer with both invasive ductal carcinoma and choriocarcinoma components in a 55-year-old woman. Firstly, the serum human chorionic gonadotropin level showed 15.9mIU/ml preoperatively. And adequate immunohistochemical tests were performed on the specimen. Secondly, High-throughput sequencing was performed to detect the molecular characteristics of the two components, respectively. Then, DNA short tandem repeat (STR) analysis confirmed the homology of the two components, indicating the somatic origin of choriocarcinoma components. Finally, the clinical course and pathological characteristics of the case were reviewed and a literature search for other cases was performed.
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Jun SY, Yoon N, An S, Kang YJ, Park CS. Clinicopathologic and Molecular Characteristics of and Diagnostic Dilemmas in Invasive Breast Carcinoma with Choriocarcinomatous Pattern apropos a New Case: A Literature Review with New Findings. Pathobiology 2022; 89:359-369. [PMID: 35354152 PMCID: PMC9811418 DOI: 10.1159/000522621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/02/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Invasive breast carcinoma with a choriocarcinomatous pattern (IBC-CP) is extremely rare, and its molecular basis is yet unclear. The choriocarcinomatous pattern is characterized by the biphasic arrangement of multinucleated syncytiotrophoblast-like cells around clusters of monotypic tumor cells in a hemorrhagic background, along with β-human chorionic gonadotropin (β-hCG) expression. The differentiation of IBC-CP from metastatic choriocarcinoma of the breast (MC-B) is difficult due to the histologic similarity. METHODS Based on a literature review and our own case, the clinicopathologic differences between IBC-CP patients (n = 17) and MC-B patients (n = 8) were analyzed. Moreover, in our case of IBC-CP, next-generation sequencing (NGS) comparative analysis was conducted for both choriocarcinomatous and invasive breast carcinoma (IBC) components. RESULTS Compared to the MC-B patients, the IBC-CP patients were older (p < 0.001) and less frequently had past histories of gestational trophoblastic disease/pregnancy/abortion (p = 0.001) and distant metastases (p = 0.005). Our case, a 49-year-old female patient, presented with masses in the right breast and axilla. Following neoadjuvant chemotherapy, a radical mastectomy found an 8.5-cm-sized tumor. Microscopically, multinucleated syncytiotrophoblast-like cells were observed around mononuclear tumor cells with hemorrhage and necrosis. Some tumor cells showed β-hCG immunopositivity, which was compatible with IBC-CP. NGS results showed a missense mutation in exon 5 of the TP53 gene in both the choriocarcinomatous and IBC components. Meanwhile, copy number loss in the PTEN gene was only identified in the choriocarcinomatous components. CONCLUSION The present IBC-CP case is triple-negative breast cancer with TP53 mutation. The PTEN gene may be associated with choriocarcinomatous differentiation. Obtaining a medical history is mandatory to exclude metastatic lesions.
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Affiliation(s)
- Sun-Young Jun
- Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea,*Sun-Young Jun,
| | - Nara Yoon
- Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Soyeon An
- Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Young-Joon Kang
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Chang Suk Park
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
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Mehta KK, Nouvini R, Liu J, Wang Y, Stopeck A. Case report: Metastatic metaplastic breast cancer with choriocarinomatous features: Targeting the choriocarcinoma component for cure. Front Oncol 2022; 12:1061679. [PMID: 36686740 PMCID: PMC9850144 DOI: 10.3389/fonc.2022.1061679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023] Open
Abstract
Breast cancer with choriocarcinomatous features (BCCF) is a rare and aggressive breast cancer. BCCF carries a poor prognosis and there is unfortunately scant literature to guide treatment beyond surgical resection with most patients receiving standard regimens for breast cancer. In our case, we present a 42-year-old female with an initial hCG of 2,324 and two suspicious lesions of the right breast. On biopsy, each lesion had distinct histopathology with the larger lesion diagnosed as BCCF and the smaller lesion being an invasive ER/PR positive ductal carcinoma. The diagnosis of BCCF rather than metastatic choriocarcinoma was confirmed using DNA typing. Salvage chemotherapy targeting choriocarcinoma resulted in marked clinical and biomarker success including normalization of the hCG. After recurrent brain metastases were diagnosed, high dose chemotherapy with methotrexate was administered resulting in long term remission.
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Affiliation(s)
- Krisha K Mehta
- Department of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Rosa Nouvini
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jingxuan Liu
- Department of Pathology, Stony Brook University, Stony Brook, NY, United States
| | - Yi Wang
- Department of Pathology, Stony Brook University, Stony Brook, NY, United States
| | - Alison Stopeck
- Department of Medicine, Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, United States
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Discrepant serum and urine β-hCG results due to production of β-hCG by a cribriform-morular variant of thyroid papillary carcinoma. Clin Chim Acta 2014; 438:181-5. [PMID: 25181612 DOI: 10.1016/j.cca.2014.08.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although patients with medullary thyroid cancer are known to present with paraneoplastic hormone production, this is much less common with papillary thyroid cancer. METHODS We present a patient with the cribriform morular variant of papillary thyroid cancer in association with familial adenomatous polyposis who developed a positive pregnancy test in the absence of known pregnancy. The patient had developed vaginal bleeding, and her laboratory testing was characterized by elevated serum human chorionic gonadotropin (β-hCG) concentrations, but negative qualitative urine results. After a thorough gynecological evaluation to exclude unexpected normal, ectopic, or molar pregnancy, we pursued an evaluation for other sources of β-hCG production. RESULTS We showed that the elevated serum β-hCG concentrations were not the result of heterophile antibody interferences, and ultimately we proved that her recurrent tumor produced the ectopic β-hCG. This is the first report of β-hCG production by papillary thyroid cancer. Thus, the possibility of ectopic production of β-hCG by papillary thyroid cancer needs to be included in the differential diagnosis of elevated hCG concentration in the absence of pregnancy. CONCLUSIONS This study of an unusual paraneoplastic syndrome highlights the importance of investigating discrepancies in the clinical laboratory.
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Zhu Y, Liu M, Li J, Jing F, Linghu R, Guo X, Jiao S, Yang J. Breast carcinoma with choriocarcinomatous features: a case report and review of the literature. World J Surg Oncol 2014; 12:239. [PMID: 25073898 PMCID: PMC4121303 DOI: 10.1186/1477-7819-12-239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 04/30/2014] [Indexed: 11/17/2022] Open
Abstract
Background Breast carcinoma with choriocarcinomatous features (BCCF) is a rare variant of breast cancer, characterized by high expression of human chorionic gonadotropin (HCG) in cancer cells such as multinucleated syncytiotrophoblast-like giant cells. The first case of BCCF was reported in 1981 by Saigo and Rosen. Only one case of BCCF was reported to show no component of breast ductal carcinoma, and only partially cancer cells, such as multinucleated syncytiotrophoblast-like giant cells, expressed HCG in all previous BCCF cases. Here, we report the first BCCF case without any component of breast ductal carcinoma in which HCG was found to express in all cancer cells. Case presentation A 32-year-old female patient presented with a small lump in her left breast 3 years prior. The mass was clinically suspected to be breast infiltrating ductal carcinoma based on breast excisional biopsy and magnetic resonance imaging findings. Due to rupture and bleeding of the left kidney, the left kidney excisional biopsy was performed. After a retrospective analysis of the initial excised breast cancer and breast cancer metastatic to the kidney, the cancer cells were positive for HCG by immunohistochemistry, and multinucleated or mononucleated giant cells resembled syncytiotrophoblastic and cytotrophoblastic cells which could be seen in a background of poor differentiated breast carcinoma and extensive necrosis and hemorrhage in the lesion. Thus, a final diagnosis of BCCF and BCCF metastatic to the kidney was made. After combination of surgical resection (the affected left breast and left kidney wereremoved) and consecutive chemotherapy consisting of docetaxel, epirubicin, cisplatin, lobaplatin, and capecitabine, the patient achieved favorable therapeutic efficacy (the HCG level returned to normal values, the metastatic lesions in the lungs disappeared, and the survival was 37 months). Capecitabine was very efficient and highly recommended due to its superior efficacy in reducing the HCG level and eliminating the metastatic lesions in the lungs. Conclusions This is the first report of a rare case of BCCF without any component of breast ductal carcinoma, featured by high expression of HCG in all cancer cells. Combination of surgery and chemotherapy (especially capecitabine) achieved a favorable therapeutic efficacy.
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Affiliation(s)
| | | | | | | | | | | | - Shunchang Jiao
- Department of Medical Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China.
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Sung HJ, Maeng YI, Kim MK, Lee SJ, Kang SM, Bong JG, Oh HK. Breast carcinoma with choriocarcinomatous features: a case report. J Breast Cancer 2013; 16:349-53. [PMID: 24155767 PMCID: PMC3800734 DOI: 10.4048/jbc.2013.16.3.349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/04/2013] [Indexed: 11/30/2022] Open
Abstract
Nongestational choriocarcinoma differentiation is extremely rare in breast neoplasms. It is characterized by tumor cells similar to chorionic trophoblastic cells, which react with human placental lactogen and human chorionic gonadotropin (hCG). A 56-year-old woman presented with a palpable right breast mass without past history of trophoblastic tumors. An F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan revealed one focus with low accumulation of FDG in the right breast (maximum standardized uptake value, 1.98). The patient underwent a right mastectomy and biopsy of sentinel nodes. Microscopically, the tumor was a typical invasive ductal carcinoma with multiple foci of choriocarcinoma features. Immunohistochemistry showed that the tumor cells resembling choriocarcinoma were positive for hCG antibody, but negative for HER2/neu, estrogen receptor, and progesterone receptor. A pathologic diagnosis of breast carcinoma with choriocarcinomatous features was made. To our knowledge, this is the first report of invasive carcinoma with choriocarcinomatous features and an unusual finding of low accumulation in an F-18 FDG PET/CT scan in Korea.
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Affiliation(s)
- Hyun-Jung Sung
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea. ; Department of Pathology, Goodsamaritan Hospital, Pohang, Korea
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Pepe LR, Strobel SL, Graham R. Anaplastic Large Cell Carcinoma with Choriocarcinomatous Features Metastatic to the Brain. J Histotechnol 2013. [DOI: 10.1179/his.2008.31.3.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Mohammadi A, Rosa M. Carcinoma of the Breast With Choriocarcinomatous Features. Arch Pathol Lab Med 2011; 135:1097-100. [DOI: 10.5858/2010-0334-rsr1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Choriocarcinomatous differentiation has been described in tumors arising from many organs including lung, rectum, colon, stomach, bladder, and rarely breast. Mammary carcinoma with choriocarcinomatous features is a rare variant of breast metaplastic carcinoma characterized by malignant cells morphologically resembling choriocarcinoma cells in which reactivity with human placental lactogen and human chorionic gonadotropin can be demonstrated by immunohistochemistry. The characteristic syncytiotrophoblast-like giant cells seen in these neoplasms are more commonly associated with moderately to poorly differentiated carcinomas with or without a clear-cut mesenchymal component. Most of the reported cases have behaved very aggressively. The reason for this poor prognosis remains unclear. Because of the small number of cases, special treatment protocols have not been developed and these patients are treated surgically and with the standard chemotherapeutic agents available for other types of carcinoma of the breast. Pathologically, these tumors must be distinguished from metastatic choriocarcinoma to the breast.
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Reisenbichler ES, Krontiras H, Hameed O. Βeta-Human Chorionic Gonadotropin Production Associated with Phyllodes Tumor of the Breast: An Unusual Paraneoplastic Phenomenon. Breast J 2009; 15:527-30. [DOI: 10.1111/j.1524-4741.2009.00772.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yamada T, Mori H, Kanemura M, Ohmichi M, Shibayama Y. Endometrial carcinoma with choriocarcinomatous differentiation: a case report and review of the literature. Gynecol Oncol 2009; 113:291-4. [PMID: 19232701 DOI: 10.1016/j.ygyno.2009.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 01/09/2009] [Accepted: 01/15/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Choriocarcinomas unrelated to pregnancy, teratomas, or germ cell tumors have been found in the stomach, lungs, colon, esophagus, bladder, breast, renal pelvis and other sites. CASE We present a case of a 58-year-old woman with endometrial carcinoma with choriocarcinomatous differentiation. She received surgery and chemotherapy for endometrial adenocarcinoma. However, a metastatic tumor of choriocarcinomatous element appeared at the vaginal cuff 9 months after surgery. Additional chemotherapy for choriocarcinoma resulted in a decrease in the serum hCG and the tumor regressed. Fifty months following surgery, she is alive without disease. CONCLUSION Treatment and follow-up must be performed not only for the adenocarcinoma element but also for the choriocarcinoma element in patients presenting with endometrial carcinoma with choriocarcinomatous differentiation.
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Affiliation(s)
- Takashi Yamada
- Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan.
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Charfi S, Ayadi L, Khanfir A, Ben Mahfoudh K, Khabir A, Bahri I, Gouiaa N, Makni S, Mnif Z, Frikha M, Sellami-Boudawara T. Métastase mammaire d’un choriocarcinome. IMAGERIE DE LA FEMME 2007. [DOI: 10.1016/s1776-9817(07)88743-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Siddiqui NH, Cabay RJ, Salem F. Fine-needle aspiration biopsy of a case of breast carcinoma with choriocarcinomatous features. Diagn Cytopathol 2006; 34:694-7. [PMID: 16955470 DOI: 10.1002/dc.20485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Breast disease is of great concern to patients and health care providers alike. Malignancies of the breast and their various presentations can pose tremendous challenges with respect to early diagnosis and effective treatment. Carcinoma of the breast may appear in several forms and produce one or more ectopic substances. Breast carcinomas that display choriocarcinomatous differentiation and produce human chorionic gonadotropin are very rare. Less than a dozen such cases have been described in the medical literature to date. We report a case of breast carcinoma with choriocarcinomatous features, which is the first to show immunohistochemical evidence of the expression of both estrogen receptor and progesterone receptor. We also discuss the cytopathologic aspects observed and conduct a literature review.
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Affiliation(s)
- Noman H Siddiqui
- Department of Pathology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
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