Primary coexistent adenocarcinoma and choriocarcinoma of the stomach. A case report and review of the literature

Collision tumor of the stomach: an unusual combination of adenocarcinoma and immature "neuroepitheliomatous" teratoma

A 54-year-old woman was diagnosed with an asymptomatic gastric tumor during routine radiological investigation for staging of breast carcinoma. Subsequent endoscopic biopsy confirmed a poorly differentiated adenocarcinoma. Surgical resection of the stomach showed a tumor with 2 distinct components: a superficial lymphoepithelioma-like adenocarcinoma and a deeper submucosal component consistent with immature teratoma. There was lymph node metastasis. The patient is well without any evidence of disease 18 months post surgery.

[Gastrointestinal adenocarcinomas with a choriocarcinomatous component: 2 cases and a review of 120 cases in the literature]

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.

Primary pulmonary choriocarcinoma combined with adenocarcinoma

An extremely rare autopsy case of primary pulmonary choriocarcinoma combined with adenocarcinomatous components in a 77-year-old Japanese man is described. The patient died of rapidly progressive respiratory dysfunction without ante-mortem diagnosis. Autopsy revealed necro-hemorrhagic areas of the primary lung tumor with a typical biphasic pattern of choriocarcinoma. Topographical analysis suggested that moderately to poorly differentiated adenocarcinoma components partially surrounded the choriocarcinomatous components. Moreover, dedifferentiated carcinomatous components were scattered next to both adenocarcinomatous and choriocarcinomatous areas, and a few cells of the dedifferentiated carcinomatous components had a similar immunoreaction to conventional adenocarcinomatous or choriocarcinomatous components, such as surfactant apoprotein A, placental alkaline phosphatase or beta-human chorionic gonadotropin. Additionally, epithelial membrane antigen-positive cytotrophoblastic cells were rarely found in choriocarcinomatous areas. The present case suggests that primary lung choriocarcinoma can occur closely related to conventional pulmonary adenocarcinoma, although collision tumor was not completely ruled out.

Primary gastric choriocarcinoma: two case reports and a pooled analysis of 53 cases

Primary gastric choriocarcinoma (PGC) is a rare tumor. In total, approximately 140 cases of PGC have been reported in the international medical literature. However, the clinical behavior, tumor characteristics, and prognostic parameters of PGC have not been clearly described. We conducted a pooled analysis to clarify the tumor characteristics and prognostic parameters in 53 patients with PGCs, including 2 patients treated at our hospital. The following variables were examined as potential prognostic factors: (1) sex, (2) age, (3) depth of invasion, (4) size, (5) histology, (6) nodal metastasis, (7) distant lymph node metastasis, (8) synchronous liver metastasis, (9) residual tumor, and (10) chemotherapy (not given or given). Univariate and multivariate analyses showed that the presence of residual tumor and synchronous liver metastasis and the absence of chemotherapy were significantly associated with an increased hazard rate (HR) of short overall survival (OS). Pooled analysis, including the two patients with PGC treated at our facility, demonstrated that the presence of a curative operation and chemotherapy, and the absence of synchronous liver metastasis were the strongest indicators of a favorable clinical course in patients with PGC.

Regulatory role of hepatocyte nuclear factor-4alpha on gastric choriocarcinoma function

Gastric choriocarcinoma is a highly aggressive carcinoma, most probably originating from somatic cells in the gastric mucosal layer. We herein investigated the regulatory role of hepatocyte nuclear factor (HNF)-4alpha, a transcriptional regulator expressed in non-neoplastic and neoplastic gastric tissues, on functions of gastric choriocarcinoma cells. HNF-4alpha cDNA was stably transfected to a gastric choriocarcinoma cell line, SCH. Alterations in SCH cell functions such as histology, ultrastructure, proliferation, production of trophoblast-specific proteins, and chemosensitivity to methotrexate (MTX) were examined. Neither in vitro and in vivo proliferations nor HLA-G expression differed significantly between the mock-transfected and HNF-4alpha-transfected SCH cells, while suppressed human chorionic gonadotropin (hCG) secretions, increased human placental lactogen (hPL) and carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) immunoreactivity, and decreased chemosensitivity to MTX were seen in HNF-4alpha-transfected SCH cells. General histologic features in xenograft nodules were unaltered, but, ultrastructurally, fascicles of paranuclear filaments were significantly more numerous in HNF-4alpha-transfected SCH cells. These results indicated an HNF-4alpha-rendered functional regulation in SCH cells, suggesting a role of transcriptional factors abundant in gastric but not in trophoblastic tissues/cells on the functional modulation of gastric choriocarcinoma cells.

Combined choriocarcinoma and adenocarcinoma of the lung occurring in a man: case report and review of the literature

BACKGROUND

Human chorionic gonadotropin (hCG)-producing large or giant cell carcinoma of the lung is not uncommon, but primary pulmonary choriocarcinoma is an extremely rare entity. Even rarer are cases occurring in males; to date the authors have found only 12 reported cases in the English literature.

METHODS

The clinical record of a 61-year-old man who presented with hemoptysis is described. A review of the literature regarding patients with primary pulmonary choriocarcinoma also is reported.

RESULTS

Computed tomography scan of the chest demonstrated an expanding thickness of the bullous wall within areas of emphysematous change in the lower lobe of the right lung. Moreover, a new, round tumor near the thickness appeared and rapidly expanded evenly into the surrounding lung tissue. Exploratory thoracotomy revealed the previous tumor to be adenocarcinoma with a small foci of choriocarcinoma, and the new tumor to be a hemorrhage with choriocarcinoma. Because of the pleural dissemination, the patient was treated with chemotherapy. At last follow-up he was alive and well with a gradually increasing serum hCG-beta level in spite of chemotherapy.

CONCLUSIONS

Primary pulmonary choriocarcinoma occurring in men is an extremely rare entity with a fatal prognosis. Of the 12 cases reported to date in the English literature, 3 cases of choriocarcinoma with the coexistence of another type of pulmonary carcinoma were reported. To the authors' knowledge the clinical relation between these two types of carcinoma are unknown because all cases to date have been detected at the time of autopsy. Only in the current study case could the clinical course of the disease be followed and pathologic confirmation achieved, although the pathogenesis of the two types of carcinoma could not be determined.