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Matsuyama T, Kubota K, Tsuruzono K, Uchida H, Hamasaki T, Mizuno K, Inoue H. Primary mediastinal choriocarcinoma requiring differentiation from non-small cell lung cancer: An autopsy case report. Respir Med Case Rep 2024; 50:102037. [PMID: 38803367 PMCID: PMC11128503 DOI: 10.1016/j.rmcr.2024.102037] [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: 01/16/2024] [Revised: 05/03/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024] Open
Abstract
A 65-year-old man with dyspnea and hemoptysis presented with a right upper lobe mass associated with enlarged mediastinal lymph nodes and bilateral pulmonary nodules on chest computed tomography (CT), suspected lung cancer. Bronchial and CT-guided biopsies revealed poorly differentiated carcinoma. His condition deteriorated rapidly before a definitive diagnosis could be made. Autopsy revealed primary mediastinal choriocarcinoma. Primary mediastinal choriocarcinomas are rare, difficult to diagnose early and have a poor prognosis. In patients with a tumor expanding across the lung and mediastinum and exhibiting pathologic findings of a pooly differentiated carcinoma, we should consider choriocarcinoma, evaluating the serum β-human chorionic gonadotropin levels.
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Affiliation(s)
- Takahiro Matsuyama
- Department of Pulmonary Medicine, Imakiire General Hospital, 43-25 Kouraicho, Kagoshima City, 890-0051, Kagoshima, Japan
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Kagoshima, Japan
| | - Koji Kubota
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Kagoshima, Japan
| | - Kentaro Tsuruzono
- Department of Pulmonary Medicine, Imakiire General Hospital, 43-25 Kouraicho, Kagoshima City, 890-0051, Kagoshima, Japan
| | - Hiroko Uchida
- Department of Pulmonary Medicine, Imakiire General Hospital, 43-25 Kouraicho, Kagoshima City, 890-0051, Kagoshima, Japan
| | - Tetsuro Hamasaki
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Kagoshima, Japan
| | - Keiko Mizuno
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Kagoshima, Japan
| | - Hiromasa Inoue
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Kagoshima, Japan
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Huang W, Zheng Z, Bao Z, Xiao X, Li L, Sun Z, Kang L. A poor prognostic male choriocarcinoma with multiple systemic metastases: a case report and the literature review. Front Med (Lausanne) 2024; 11:1382672. [PMID: 38572155 PMCID: PMC10989191 DOI: 10.3389/fmed.2024.1382672] [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: 02/06/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
Background Non-gestational choriocarcinoma, also known as primary choriocarcinoma, is extremely rare in men, manifesting with specific signs such as breast feminization, testicular atrophy, and loss of libido. The presentation typically includes elevated serum β-hCG levels, widespread metastatic disease, and a rapid progression of the condition. Case report We present a rare case of a 41-year-old man diagnosed with choriocarcinoma, exhibiting a unique combination of multiple metastases, including lung, brain, bone, and retroperitoneal lymph node metastases, as confirmed by 18F-FDG PET/CT imaging. The patient was treated with aggressive chemotherapy and pembrolizumab, and the prognosis remained poor. The patient's overall survival was a mere 5 months following diagnosis. Conclusion Non-gestational choriocarcinoma represents a rare entity in clinical practice and should be considered in young men presenting with gynaecomastia and elevated β-hCG levels alongside normal gonads. Thus, we advocate for a more comprehensive inquiry into medical history and a systematic examination. The 18F-FDG PET/CT examination not only visually delineates the lesion's location and extent but also serves as a cornerstone for clinical tumor staging, providing valuable support for treatment monitoring and subsequent follow-up.
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Affiliation(s)
- Wenpeng Huang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Zuohuan Zheng
- Department of Traditional Chinese Medicine, The Seventh People’s Hospital of Chongqing, Chongqing, China
| | - Zheng Bao
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Xiaoyan Xiao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Liming Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Zhaonan Sun
- Department of Medical Imaging, Peking University First Hospital, Beijing, China
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
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3
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Kong L, Zhou Y, Zhang Y, Kong Z. A rare case of a male primary mediastinal choriocarcinoma accompanying lung metastasis. Asian J Surg 2024; 47:636-637. [PMID: 37806885 DOI: 10.1016/j.asjsur.2023.09.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Li Kong
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, China
| | - Yang Zhou
- Department of Ultrasound, The First Affiliated Hospital of DaLian Medical University, DaLian City, China
| | - Ying Zhang
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, China
| | - Zixuan Kong
- Department of Radiology, The Second Affiliated Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, China.
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Ammar H, Said MA, Beltaifa M, Azri M, Zgaya R, Majdoub W, Belkacem O, Gupta R, Ben Hamada H, Ben Ali A. Recurrent Life-Threatening Gastrointestinal Bleeding From Primary Intestinal Choriocarcinoma: A Case Report. Cureus 2023; 15:e41823. [PMID: 37575827 PMCID: PMC10423014 DOI: 10.7759/cureus.41823] [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] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Choriocarcinoma is a highly aggressive, malignant tumor that arises from trophoblastic cells. Although choriocarcinomas usually arise in the genital organs, they can also originate in extragenital organs, but gastrointestinal tract lesions are rare. Gastrointestinal choriocarcinoma can be primary or metastatic. Most primary gastrointestinal choriocarcinomas are associated with adenocarcinomas. We report a case of jejunal choriocarcinoma presenting with acute abdominal pain and intestinal bleeding. The patient had a very high serum beta-human chorionic gonadotropin (β-HCG) level with an isolated jejunal lesion on contrast-enhanced computed tomography of the abdomen and pelvis. The patient underwent emergency surgical resection of the jejunal lesion with good recovery. The histopathological analysis of the resected specimen confirmed the diagnosis of choriocarcinoma. However, the patient suffered from life-threatening rebleeding one month after surgery and succumbed to her illness.
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Affiliation(s)
- Houssem Ammar
- General Surgery, Sahloul Hospital, University of Sousse, Sousse, TUN
| | | | - Mahdi Beltaifa
- General Surgery, Sahloul Hospital, University of Sousse, Sousse, TUN
| | - Marwa Azri
- General Surgery, Sahloul Hospital, University of Sousse, Sousse, TUN
| | - Rym Zgaya
- Obstetrics and Gynaecology, Farhat Hached Hospital, University of Sousse, Sousse, TUN
| | - Wiem Majdoub
- Pathology, Sahloul Hospital, University of Sousse, Sousse, TUN
| | | | - Rahul Gupta
- Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND
| | - Habiba Ben Hamada
- Anaesthesiology, Sahloul Hospital, University of Sousse, Sousse, TUN
| | - Ali Ben Ali
- General Surgery, Sahloul Hospital, University of Sousse, Sousse, TUN
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5
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Nasr AMA, Ahmed YAM, Gafar AAM, Ahmed SA, Barri BKA, TalibMeshref E, Ahamed EAM, Alanazi WA. Prevalence and Risk Factors of Choriocarcinoma in Saudi Arabia: A Systematic Review. CLINICAL CANCER INVESTIGATION JOURNAL 2022. [DOI: 10.51847/nczqkf18st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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6
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Mnikhovich MV, Ovakimian TR, Romanov AV, Bezuglova TV, Snegur SV, Pavlova YG, Kokoreva AY. [Primary choriocarcinoma of the liver in a 36-year-old male patient. A case report and literature review]. Arkh Patol 2022; 84:56-60. [PMID: 36469719 DOI: 10.17116/patol20228406156] [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: 06/17/2023]
Abstract
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.
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Affiliation(s)
- M V Mnikhovich
- Avtsyn Research Institute of Human Morphology of Federal state budgetary scientific institution «Petrovsky National Research Centre of Surgery», Moscow, Russia
| | - T R Ovakimian
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Romanov
- Avtsyn Research Institute of Human Morphology of Federal state budgetary scientific institution «Petrovsky National Research Centre of Surgery», Moscow, Russia
| | - T V Bezuglova
- Avtsyn Research Institute of Human Morphology of Federal state budgetary scientific institution «Petrovsky National Research Centre of Surgery», Moscow, Russia
| | - S V Snegur
- Ryazan Regional Clinical Hospital, Ryazan, Russia
| | - Yu G Pavlova
- Ryazan Regional Clinical Hospital, Ryazan, Russia
| | - A Yu Kokoreva
- Pirogov Russian National Research Medical University, Moscow, Russia
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El-Zaatari ZM, Ro JY. Mediastinal Germ Cell Tumors: A Review and Update on Pathologic, Clinical, and Molecular Features. Adv Anat Pathol 2021; 28:335-350. [PMID: 34029275 DOI: 10.1097/pap.0000000000000304] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mediastinal germ cell tumors (MGCTs) are the most common extragonadal germ cell tumors (GCTs) and most often arise in the anterior mediastinum with a male predilection. MGCTs also have a predilection for patients with Klinefelter syndrome and possibly other genetic conditions. MGCTs, as GCTs at other extragonadal sites, are thought to arise from germ cells improperly retained during migration along the midline during embryogenesis. Similar to their counterparts in the testes, MGCTs are classified into seminomatous and nonseminomatous GCTs. Seminomatous MGCT represents pure seminoma, whereas nonseminomatous MGCTs encompass pure yolk sac tumors, embryonal carcinoma, choriocarcinoma, mature or immature teratoma, and mixed GCTs with any combination of GCT types, including seminoma. Somatic-type or hematologic malignancies can also occur in association with a primary MGCT. MGCTs share molecular findings with GCTs at other sites, most commonly the presence of chromosome 12p gains and isochromosome i(12p). Treatment includes neoadjuvant chemotherapy followed by surgical resection of residual tumor, with the exception of benign teratomas, which require only surgical resection without chemotherapy. In this review, we highlight and provide an update on pathologic, clinical, and molecular features of MGCTs. Immunohistochemical profiles of each tumor type, as well as differential diagnostic considerations, are discussed.
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Affiliation(s)
- Ziad M El-Zaatari
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
- Weill Medical College of Cornell University (WCMC), New York, NY
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Yoon J, Hu S, Farrell J, Shah KK, Chintanaboina JK. An Exceptionally Rare Cause of Refractory Gastrointestinal Bleed: Choriocarcinoma Syndrome. Cureus 2021; 13:e14599. [PMID: 34040900 PMCID: PMC8139606 DOI: 10.7759/cureus.14599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Testicular choriocarcinomas comprise less than 1% of all testicular tumors and are often highly vascular with early hematogenous metastasis. Choriocarcinoma syndrome (CS) is a rare entity distinguished by diffuse tumor burden and often fatal bleeding from metastatic sites. Most reported cases describe pulmonary hemorrhage secondary to initiation of chemotherapy. We present a fatal case of a young, previously healthy male with overwhelming gastrointestinal bleeding as the presenting sign of CS. Our case demonstrates that CS should be considered in the differential diagnosis for refractory anemia due to gastrointestinal hemorrhage in a young male with a testicular mass.
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Affiliation(s)
- Jennifer Yoon
- Internal Medicine, University of California San Francisco Fresno, Fresno, USA
| | - Steve Hu
- Gastroenterology and Hepatology, University of California San Francisco Fresno, Fresno, USA
| | | | - Kandarp K Shah
- Gastroenterology and Hepatology, Community Medical Center, Fresno, USA
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Yun J, Lee SW, Lim SH, Kim SH, Kim CK, Park SK. Successful treatment of a high-risk nonseminomatous germ cell tumor using etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine: A case report. World J Clin Cases 2020; 8:5334-5340. [PMID: 33269267 PMCID: PMC7674725 DOI: 10.12998/wjcc.v8.i21.5334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/25/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Choriocarcinoma is an infrequent entity and the most aggressive subtype of germ-cell tumors. Because of early metastatic spread and rapid disease progression, choriocarcinoma patients display poor prognosis. Although etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) regimen is widely used to treat gestational trophoblastic tumors in females, its role in treating male choriocarcinoma is seldom reported.
CASE SUMMARY A 32-year-old man was diagnosed with burned-out primary germ cell tumors (GCT) with retroperitoneum, liver and lung metastases. Biopsy of the liver revealed pure choriocarcinoma. The patient received bleomycin, etoposide, and cisplatin chemotherapy. After two cycles of treatment, response evaluation revealed the mixed response. EMA-CO regimen was used in the second-line therapy. After eight cycles, the patient showed a potentially resectable state and thus, all residual masses were surgically removed. The patient was completely cured, and 10 years later, he is leading a healthy life without complications.
CONCLUSION This paper is the first case of high-risk nonseminomatous GCT in a male patient to be successfully treated with the EMA-CO regimen. The EMA-CO regimen can be used actively in patients with high-risk nonseminomatous GCT.
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Affiliation(s)
- Jina Yun
- Department of Internal Medicine, Division of Hematology-Oncology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, South Korea
| | - Sang W Lee
- Department of Urology and Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, South Korea
| | - Sung H Lim
- Department of Internal Medicine, Division of Hematology-Oncology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, South Korea
| | - Se H Kim
- Department of Internal Medicine, Division of Hematology-Oncology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, South Korea
| | - Chan K Kim
- Department of Internal Medicine, Division of Hematology-Oncology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, South Korea
| | - Seong K Park
- Department of Internal Medicine, Division of Hematology-Oncology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, South Korea
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Al Salman O, Malik F, Trivedi S, Alchalabi M, Chaudhari S. Gastrointestinal Bleeding with Hemodynamic Repercussion due to a Gastric Metastatic Lesion of a Testicular Choriocarcinoma in a Previously Asymptomatic Young Adult. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2020; 27:212-214. [PMID: 32509930 DOI: 10.1159/000502259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/21/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Omar Al Salman
- Internal Medicine, Metropolitan Hospital Center, New York, New York, USA
| | - Fahad Malik
- Internal Medicine, Richmond University Medical Center, Staten Island, New York, USA
| | - Shashank Trivedi
- Internal Medicine, Metropolitan Hospital Center, New York, New York, USA
| | - Marwah Alchalabi
- Internal Medicine, Metropolitan Hospital Center, New York, New York, USA
| | - Shobhana Chaudhari
- Internal Medicine, Metropolitan Hospital Center, New York, New York, USA
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11
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Testicular Choriocarcinoma Metastasizing to the Small Bowel Causing Intussusception: Case Report. J Gastrointest Cancer 2020; 50:1005-1008. [PMID: 30368692 DOI: 10.1007/s12029-018-0172-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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12
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Han C, Zhou Y, Ma JA, Liu J, Jiang YN, Zhang HX. A promising treatment option for refractory male primary choriocarcinoma: report of two cases. Transl Cancer Res 2020; 9:3054-3060. [PMID: 35117666 PMCID: PMC8799262 DOI: 10.21037/tcr.2020.02.05] [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: 12/10/2019] [Accepted: 01/18/2020] [Indexed: 12/26/2022]
Abstract
Male primary choriocarcinoma is a rare and invasive malignant neoplasm for which traditional chemotherapy has limited efficacy. Pembrolizumab is a humanized monoclonal anti-programmed death-1 antibody that has antitumor activity in numerous malignancies. The diagnosis and treatment of two cases of advanced male primary choriocarcinoma were retrospectively analyzed and relevant literature was reviewed to discuss the prognosis and the efficacy of different treatments, including pembrolizumab. The first patient, who presented with cough and hemoptysis, was diagnosed with primary mediastinal choriocarcinoma. He initially responded to the first-line chemotherapy of etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine, but eventually developed brain metastases. The patient did not respond to the second-line chemotherapy comprising paclitaxel and cisplatin, and he died 6.5 months after diagnosis. The second patient experienced repeated episodes of abdominal pain and was diagnosed with primary neck choriocarcinoma. He received chemotherapy regimens similar to those of the first patient. However, imaging showed no significant changes and his clinical symptoms were not improved. Immunohistochemistry showed that the expression of programmed death ligand 1 on the tumor cells was 40%, and he was administered pembrolizumab combined with chemotherapy. He achieved complete response and was subsequently switched to pembrolizumab maintenance monotherapy. He is still alive without evidence of disease 36 months after diagnosis. To our knowledge, this is the first case of advanced male primary choriocarcinoma successfully treated with pembrolizumab combined with chemotherapy. Advanced male primary choriocarcinoma is highly aggressive and insensitive to chemotherapy. Pembrolizumab may provide a promising treatment option to improve patient outcomes.
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Affiliation(s)
- Chen Han
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Ying Zhou
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Jin-An Ma
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Jia Liu
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Yu-Na Jiang
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Hai-Xia Zhang
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
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Zhao W, Chen T, Yang Y. Primary extragenital choriocarcinoma in posterior mediastinum in a male adult: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:703. [PMID: 31930104 DOI: 10.21037/atm.2019.09.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary extragenital choriocarcinoma is a highly malignant tumor and usually occurs in the midline of the body, such as the mediastinum, retroperitoneum, pineal gland and the middle part of the brain. In this report we present a case of primary extragenital choriocarcinoma located in the posterior mediastinum. A 40-year-old man was admitted to hospital with severe chest wall pain for 2 months. Enhanced chest computed tomography (CT) showed a mass of soft tissue measuring 5.2 cm × 4.5 cm located in the posterior mediastinum. CT-guided percutaneous fine needle aspiration (FNA) biopsy was performed and adenocarcinoma was diagnosed. After careful examination, complete tumor resection with combined resection of part left upper lobe of lung and lymph node dissection were performed. Combining hematoxylin/eosin staining and immunohistochemical a pathological diagnosis of choriocarcinoma was made.
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Affiliation(s)
- Weigang Zhao
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200030, China
| | - Tangbing Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yi Yang
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200030, China
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14
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Abstract
RATIONALE Choriocarcinoma is a rare and highly invasive gestational trophoblastic tumor that secretes high levels of human chorionic gonadotropin (hCG). As one of the uncommon non-gestational choriocarcinoma, primary mediastinal choriocarcinoma is an exceeding rare, and aggressive malignancy with poor prognosis. PATIENT CONCERNS A 26-year-old man was admitted to the hospital with cough, shortness of breath, and occasional hemoptysis. DIAGNOSES AND INTERVENTION Imaging examinations revealed a large mediastinal mass, diffuse nodular opacities with blurred edges in both lungs, and multiple brain lesions. Laboratory tests showed an astonishing increase of serum β-hCG. A diagnosis of primary mediastinal choriocarcinoma with advanced lung and brain metastases was finally made after 3 biopsies and immunohistochemical analyses. Surgery and radiotherapy were not applicable at the time of diagnosis, and both targeted therapy and immunotherapy were unavailable. During the first 4 cycles of trophoblastic tumor-based chemotherapy, the patient improved clinically with fewer symptoms, decreased β-hCG and reduced lesions. However, drug resistance quickly emerged, forcing an alternative chemotherapy regimen that also failed. OUTCOMES The patient finally endured symptoms including headache, dizziness and vomiting, and subsequently succumbed after an overall survival time of six and half months. LESSONS Male primary choriocarcinoma is an extremely rare type of malignancy. Greater awareness, earlier diagnosis and novel treatments are urgently needed to benefit patients.
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15
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Qiu J, Jia S, Li G. Incidence and prognosis factors of extragonadal choriocarcinoma in males: a population-based study. Cancer Manag Res 2018; 10:4565-4573. [PMID: 30410393 PMCID: PMC6197831 DOI: 10.2147/cmar.s175948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Choriocarcinoma usually occurs in females and sometimes occurs in the testicles of males. Extragonadal choriocarcinoma in males was previously described in case reports, and our understanding of this type of cancer has remained limited. The purpose of this study was to explore the incidence, treatment and prognostic factors of extragonadal choriocarcinoma in males. Materials and methods Two cohorts were identified from the Surveillance, Epidemiology, and End Results (SEER) Program by histology, tumor site and sex. One cohort of 115 patients was created using the SEER nine registries (1973–2014) to estimate the incidence. The other cohort of 197 patients was created using the SEER 18 registries (1973–2013) to estimate the patient demographics and survival. Results The median age at diagnosis was 30 years. The most common primary tumor location was the mediastinum followed by the retroperitoneum and the brain. Approximately 23% of patients underwent beam radiation therapy, whereas 63.5% underwent surgery. The estimated one- and 5-year cause-specific survival rates were 49% and 35%, respectively. The multivariate analysis showed that the age at diagnosis, ie, a younger age of 0–19 years old, and the primary tumor site, ie, the brain, were the independent prognostic factors and were correlated with a favorable prognosis. The median survival time of patients was 186 months, 13 months and 4 months in the 0–19, 20–49 and 50+ years of age, respectively. Conclusion Extragonadal choriocarcinoma in males is a rare malignancy with a poor prognosis. A young age at diagnosis and primary tumor site in the brain were the independent prognostic factors.
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Affiliation(s)
- Jingping Qiu
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China,
| | - Shi Jia
- 7th General Surgery Unit, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guang Li
- Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, China,
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16
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Li Y, Chen G, Chen H, Wen S, Xiong CY, Yang ZY, Zhu YX, Jeffreys N. Spontaneous renal hemorrhage secondary to choriocarcinoma in a man with congenital hypospadias and cryptorchidism: a case report and literature review. BMC Cancer 2018; 18:543. [PMID: 29739453 PMCID: PMC5941373 DOI: 10.1186/s12885-018-4424-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Choriocarcinoma is a rare malignant germ-cell tumour, most commonly found in adult women. It infrequently presents as spontaneous renal haemorrhage (SRH). Genital malformation and SRH secondary to choriocarcinoma has previously been only reported in females. We present what we believe to be the first case of a male patient with genital malformation (hypospadias and cryptorchidism) and SRH at presentation of choriocarcinoma. Case presentation A 25-year-old man presented to the department with intense pain in the right flank region and lower back. Initial investigations showed spontaneous renal haemorrhage, for which an emergency partial nephrectomy was performed. Clinical, radiological, and pathological investigations suggested a diagnosis of testicular choriocarcinoma with metastases to the right kidney, both lungs, and brain. Initial treatment was with a chemotherapy regimen of cisplatin, etoposide and bleomycin and whole brain radiotherapy; however, 6 months after diagnosis the patient developed liver metastasis, after which time the BEP protocol was switched to ITP with oral apatinib. Despite best efforts, the liver and lung metastasis continued to grow and a decision was made to discontinue active treatment and provide only palliative care until the patient passed away. Conclusion Choriocarcinoma is a difficult cancer to diagnose pre-operatively. In male patients with early metastasis, prognosis may be much poorer than in the commoner gestational choriocarcinoma. A multidisciplinary with comprehensive post-surgical intervention is of great importance in the treatment of these patients.
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Affiliation(s)
- Yi Li
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, 400016, Chongqing, China
| | - Gang Chen
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, 400016, Chongqing, China.
| | - Han Chen
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, 400016, Chongqing, China
| | - Shuang Wen
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, 400016, Chongqing, China
| | - Chao-Yu Xiong
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, 400016, Chongqing, China
| | - Zi-Yi Yang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, 400016, Chongqing, China
| | - Yun-Xiao Zhu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong District, 400016, Chongqing, China
| | - Nathan Jeffreys
- University College London Medical School, Medical School Building, 74 Huntley Street, London, WC1E 6BT, England, UK
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Duong J, Ghanchi H, Miulli D, Kahlon A. Metastatic Nongestational Choriocarcinoma to the Brain: Case Report and Proposed Treatment Recommendations. World Neurosurg 2018; 115:170-175. [PMID: 29678709 DOI: 10.1016/j.wneu.2018.04.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 04/08/2018] [Accepted: 04/09/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Nongestational choriocarcinoma (NGC) is a rare germ cell tumor, accounting for <0.6% of all gestational tumors, and has a poor prognosis when metastasized. NGC with metastasis to the brain is reported even less frequently. Gestational choriocarcinoma (GC) when metastasized to the brain has a higher morbidity and mortality but has been known to be a chemosensitive and radiosensitive lesion, and NGC is chemoresistant with an even worse prognosis. Currently, there is no consensus for treatment for metastatic NGC to the brain. CASE DESCRIPTION This 66-year-old postmenopausal female presented with left upper extremity weakness more pronounced in her hand and a workup demonstrating a hemorrhagic lesion over the right frontal parietal lobe. Her metastatic workup was negative, leading to a craniotomy for resection of the mass. The pathology was consistent with metastatic GC of nongestational origin. CONCLUSIONS Because of its chemosensitive nature, reports of optimal metastatic GC treatment include radiation alone, chemotherapy without radiation, surgical resection, or combined multimodal therapy. No recommendations for NGC metastasized to the brain have been reported. We propose a systematic workup for hemorrhagic brain lesions to include the proposed imaging modalities and serum markers, including β-human chorionic gonadotropin, to aid early diagnosis. Based on a review of the literature, we recommend surgical resection with adjuvant therapy for accessible symptomatic metastatic GC and NGC to the brain for optimal patient outcomes. Chemotherapy and radiation alone without surgical resection can be considered for asymptomatic GC metastasis to the brain.
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Affiliation(s)
- Jason Duong
- Department of Neurosurgery, Riverside University Health System, Moreno Valley, California, USA.
| | - Hammad Ghanchi
- Department of Neurosurgery, Riverside University Health System, Moreno Valley, California, USA
| | - Dan Miulli
- Department of Neurosurgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Avneet Kahlon
- College of Osteopathic Medicine, Touro University, Vallejo, California, USA
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18
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Sim JXY, Binte Mohamed Hussain IH, Leow WQ. Metastatic disease masquerading as small intestinal tumoural masses: two case reports and literature review. PROCEEDINGS OF SINGAPORE HEALTHCARE 2017. [DOI: 10.1177/2010105817691996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Metastatic disease presenting clinically as small intestinal tumoural masses has been described in the literature but is uncommon. It is imperative to consider the possibility of metastases before diagnosing a primary small intestinal malignancy. We hereby illustrate two such case reports of metastatic disease presenting as tumoural masses in the small intestines. First is a 63-year-old gentleman with known metastatic renal cell carcinoma (RCC) who presented with intestinal obstruction. Radiological imaging of the abdomen revealed a jejuno-jejunal intussusception, secondary to a solitary polypoid tumour. Histology of the polypoid tumour confirmed the presence of clear cell RCC. In our literature review, we note that intussusception is a common presentation in metastatic RCC to the small intestines. Hence, this clinical feature may be useful in determining a metastatic process, even in the setting of a solitary lesion. Second is a 41-year-old lady who presented with massive bleeding from the upper gastrointestinal tract. Gross examination of the distal duodeno-jejunectomy specimen reveals aggregates of reddish polypoid tumours. Histological and immunohistochemical techniques culminated in a diagnosis of metastatic choriocarcinoma. Metastatic choriocarcinoma to the small intestines is uncommon, but careful evaluation of histological features coupled with the judicious use of immunohistochemistry and a degree of suspicion can help make the correct diagnosis. In conclusion, metastatic disease masquerading as small intestinal tumoural masses is not uncommon. Judicious use of immunohistochemistry, in addition to the careful identification of pertinent clinical and histological features, can help pathologists reach the correct diagnosis.
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Affiliation(s)
- Jovell Xing Yi Sim
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital, Singapore
| | | | - Wei Qiang Leow
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital, Singapore
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Markwerth P, Madea B, Kristiansen G, Doberentz E. Chorionkarzinom als seltene Ursache eines plötzlichen Todes eines 33-jährigen Mannes. Rechtsmedizin (Berl) 2017. [DOI: 10.1007/s00194-017-0148-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Barbieux J, Memeo R, De Blasi V, Suciu S, Faucher V, Averous G, Roy C, Marescaux J, Mutter D, Pessaux P. Real case of primitive embryonal duodenal carcinoma in a young man. World J Gastroenterol 2017; 23:730-734. [PMID: 28216981 PMCID: PMC5292348 DOI: 10.3748/wjg.v23.i4.730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/05/2016] [Accepted: 09/14/2016] [Indexed: 02/06/2023] Open
Abstract
We report here the case of a young man suffering from a rare germ cell tumour. The patient was a 25-year-old man who was referred to our centre for asthenia, stinging epigastric pain, and an iron deficiency anaemia. Gastroscopy revealed a circumferential vegetating lesion on the second portion of the duodenum. The lesion was indurated at the third portion of the duodenum, responsible for a tight stenosis. A computerized tomography-scan of the chest, abdomen and pelvis, and a pancreatic MRI showed a circumferential lesion with a bi-ductal dilatation (i.e., of the common bile duct and Wirsung’s duct) without metastatic localisation. The patient underwent a pancreaticoduodenectomy with lymph node dissection including all cellular adipose tissues of the hepatic pedicle from the hepatic common artery and of the retroportal lamina. Histological findings were suggestive of a duodenal embryonal carcinoma with pancreatic infiltration. This is the second published case highlighting the duodenal primitive localisation of an embryonal carcinoma with pancreatic infiltration.
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21
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Metastatic choriocarcinoma as initial presentation of small bowel perforation in absence of primary uterine lesion: a case report. TUMORI JOURNAL 2016; 102:D07579C9-2D29-4270-B169-20841C554FB7. [PMID: 26166218 DOI: 10.5301/tj.5000379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Choriocarcinoma is a highly malignant tumor of gestational trophoblastic neoplasia that characteristically spreads via the bloodstream. Small bowel metastasis is very rare, and a small number of cases of choriocarcinoma metastasis to small bowel have been reported. METHODS We report a case of a 40-year-old woman presenting with acute abdominal pain and vaginal bleeding due to small bowel perforation secondary to jejunal metastasis. In our case, metastatic choriocarcinoma was present in the small bowel, lung, and liver, but no primary lesion was apparent. RESULTS After resection and anastomosis of the perforated small bowel, chemotherapy was performed. The patient began chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) for 9 cycles. When the 4th cycle of chemotherapy was finished, β-human chorionic gonadotropin (hCG) level was normalized and follow-up computed tomography scans showed regression of the liver metastasis and small bowel lesion and significantly decreased lung metastasis. After 9 cycles of chemotherapy were completed, the patient showed complete response. CONCLUSIONS If patients have high β-hCG of unknown origin and suspected panperitonitis, which are suspicious of choriocarcinoma metastasis to small bowel, the pathologic findings are important. It is essential to confirm the histopathologic diagnosis postoperatively. Choriocarcinoma can spread to various organs and show aggressive manifestations. Therefore, we should be aware of possible metastatic sites and remain alert to its diagnosis.
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Abstract
The mediastinum is among the most frequent anatomic region in which germ cell tumors (GCT) arise, second only to the gonads. Mediastinal GCT (mGCT) account for 16 % of all mediastinal neoplasms. Although the morphology and (according to all available data) the molecular genetics of mediastinal and gonadal GCT are identical, a number of unique aspects exist. There is a highly relevant bi-modal age distribution. In pre-pubertal children of both sexes, mGCT consist exclusively of teratomas and yolk sac tumors. The prognosis is generally favorable with modern treatment. In post-pubertal adults, virtually all patients with malignant mGCT are males; the prognosis is more guarded and depends (among other factors) on the histological GCT components and is similar to GCT in other organs. So-called somatic type malignancies (i. e. clonally related, non-germ cell neoplasias arising in a GCT) are much more frequent in mGCT than in other organs, and the association between mediastinal yolk sac tumors and hematological malignancies, such as myelodysplasias and leukemias, is unique to mediastinal tumors. The prognosis of GCT with somatic type malignancies is generally dismal.
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Affiliation(s)
- F Bremmer
- Institut für Pathologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - P Ströbel
- Institut für Pathologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
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23
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Wei H, Zhang T, Liu B, Xue X, Wang G. Choriocarcinoma of unknown origin with multiple organ metastasis and cerebral hemorrhage: A case report and literature review. Oncol Lett 2016; 11:3749-3752. [PMID: 27313687 DOI: 10.3892/ol.2016.4463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/18/2016] [Indexed: 12/20/2022] Open
Abstract
A 26-year-old man was admitted to Beijing Friendship Hospital, Capital Medical University (Beijing, China) with a 4-day history of headache, moderate fever and numbness in the right upper limb. Prior to this, the patient had been diagnosed with cerebral hemorrhage by computed tomography (CT) scan upon visiting a local hospital. Chest X-ray revealed multiple lesions in the lungs. Following referral, no abnormalities were found elsewhere, including in the testes, during a physical examination. Additional examination of other tumor biomarkers was unremarkable, and the initial suspicion of parasitic infection was ruled out. Tests revealed extremely high levels of β-human chorionic gonadotropin (>200,000 mIU/ml). In addition, CT scans showed multiple metastases in the head, lungs, liver and kidneys. An ultrasound-guided Tru-Cut biopsy of the liver was performed in order to form a definitive diagnosis. Although the patient was treated with mannitol to reduce intracranial pressure, and with cefoperazone sodium and sulbactam sodium to fight infection, the patient succumbed to a cerebral hernia on the fourth day of hospitalization. Following this, the ultrasound-guided Tru-Cut liver biopsy result was received, which suggested a diagnosis of choriocarcinoma.
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Affiliation(s)
- Hongtao Wei
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Tianpeng Zhang
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Bing Liu
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Xiaowei Xue
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Guoxing Wang
- Department of Emergency, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P.R. China
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24
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Zhang J, Wang ZJ, Yang B, Wei YY, Yang L, Hu Y, Hu YP. Biochemical remission by chemoradiotherapy in male mediastinal choriocarcinoma with diffuse lung metastasis: A case report. Oncol Lett 2016; 11:2615-2618. [PMID: 27073527 DOI: 10.3892/ol.2016.4248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 01/29/2016] [Indexed: 12/27/2022] Open
Abstract
Primary mediastinal choriocarcinoma is a rare malignancy that is characterized by multiple metastases at the time of diagnosis, poor response to therapy and short survival times. There is no standard treatment for this disease. The present study described the case of a 25-year-old man with metastatic mediastinal choriocarcinoma. The patient completed 8 cycles of standard combination chemotherapy consisting of etoposide [100 mg/m2; intravenous (IV) drip on days 1-3], cisplatin (20 mg/m2; IV drip on days 1-5) and bleomycin (20 mg/m2; intramuscular injection on days 1, 8 and 15 every 21 days). The α-fetoprotein level decreased to 2.36 ng/ml, the serum β-human chorionic gonadotropin (β-HCG) level markedly decreased to 8.69 IU/l, which was slightly higher than the normal upper limit, and the lactate dehydrogenase level decreased to a normal range. The computed tomography (CT) scan revealed that the number and size of the lung lesions was significantly reduced subsequent to 8 cycles of chemotherapy and the size of the mediastinal tumor was evidently reduced, with a less solid component and a more cystic component. The response assessment indicated partial remission. Following chemotherapy, a radiation dose of 50 Gy (2.0 Gy/fraction) was administered to the involved field of the mediastinum. Following radiotherapy, the β-HCG level had also decreased to normal levels, and CT evaluation revealed that the size of the residual lung lesions demonstrated no evident change, and the mediastinal tumor was slightly reduced in size, with a less solid component. The patient refused to undergo surgery and did not receive additional treatment following radiotherapy. At present, the patient has survived >16 months of follow-up without any symptoms.
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Affiliation(s)
- Jing Zhang
- Department of Medical Oncology, Hubei Cancer Hospital, Wuhan, Hubei 430079, P.R. China
| | - Zhi-Jun Wang
- Department of Medical Oncology, Hubei Cancer Hospital, Wuhan, Hubei 430079, P.R. China
| | - Bin Yang
- Department of Medical Oncology, Hubei Cancer Hospital, Wuhan, Hubei 430079, P.R. China
| | - You-Ying Wei
- Department of Medical Oncology, Hubei Cancer Hospital, Wuhan, Hubei 430079, P.R. China
| | - Ling Yang
- Department of Medical Oncology, Hubei Cancer Hospital, Wuhan, Hubei 430079, P.R. China
| | - Yang Hu
- Department of Medical Oncology, Hubei Cancer Hospital, Wuhan, Hubei 430079, P.R. China
| | - Yan-Ping Hu
- Department of Medical Oncology, Hubei Cancer Hospital, Wuhan, Hubei 430079, P.R. China
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25
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Metastatic Testicular Choriocarcinoma: A Rare Cause of Upper GI Bleeding. ACG Case Rep J 2015; 3:36-8. [PMID: 26504875 PMCID: PMC4612755 DOI: 10.14309/crj.2015.94] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/08/2015] [Indexed: 12/27/2022] Open
Abstract
We present a case of upper gastrointestinal bleeding in an otherwise healthy 18-year-old man who presented with melena. Endoscopy revealed an ulcerated mass in the stomach and pathology confirmed this to be a malignant, poorly differentiated choriocarcinoma. Further imaging showed a left testicular mass with evidence of pulmonary, gastric, and brain metastases, and blood tests revealed an hCG level of 32,219 U/L. He was diagnosed with advanced metastatic testicular choriocarcinoma and underwent intensive induction chemotherapy and an orchidectomy. Metastatic testicular choriocarcinoma is a rare cause of gastrointestinal bleeding.
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26
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Abstract
Testicular germ cell tumors represent the most common malignancy among young men. While 5-year overall survival and cure for this population is greater than 95%, choriocarcinoma is an aggressive subtype of this disease with far worse prognosis--5-year survival for choriocarcinoma is less than 80%. In order to be able to treat these patients appropriately, a provider must recognize characteristic features of choriocarcinoma including elevated human chorionic gonadotropin in a young man with testicular mass; the astute clinician should also know the signs and symptoms of choriocarcinoma syndrome, characterized by bleeding from metastatic sites, which represents a medical emergency and is associated with high morbidity and mortality. Treatment should be directed towards a goal of tumor marker normalization, and patients with refractory disease should be considered for advanced therapies and clinical trials. Choriocarcinoma is a unique and aggressive germ cell malignancy, and these patients require early aggressive treatment to improve their chance of survival.
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27
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Metastatic Choriocarcinoma of the Small Intestine Presenting as Refractory Anemia and Melena. ACG Case Rep J 2015; 2:131-2. [PMID: 26157939 PMCID: PMC4435411 DOI: 10.14309/crj.2015.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 03/16/2015] [Indexed: 11/26/2022] Open
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28
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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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29
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A case of gastrointestinal bleeding due to duodenal metastasis from a testicular choriocarcinoma. J Gastrointest Cancer 2013; 44:234-7. [PMID: 22961707 DOI: 10.1007/s12029-012-9433-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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30
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Guo J, Zhong C, Liu Q, Xu J, Zheng Y, Xu S, Gao Y, Guo Y, Wang Y, Luo Q, Jiang J. Intracranial choriocarcinoma occurrence in males: Two cases and a review of the literature. Oncol Lett 2013; 6:1329-1332. [PMID: 24179518 PMCID: PMC3813813 DOI: 10.3892/ol.2013.1570] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 08/30/2013] [Indexed: 12/20/2022] Open
Abstract
Choriocarcinomas generally develop in females. Non-gestational choriocarcinoma in males is extremely rare. The present study describes two cases of young males who were diagnosed with intracranial choriocarcinoma. One case was of an aggressive choriocarcinoma with multiple metastases to the brain, but with an unidentified origin. The patient was admitted in the terminal stage of the cancer. Although a tumor resection was performed, the condition of the patient rapidly deteriorated and chemotherapy was not recommended. The patient succumbed nine days after the surgery. The second case was of a primary ventricular choriocarcinoma. The patient was hospitalized for acute hydrocephalus caused by a mass that was located in the ventricle. Following a tumor resection, the patient underwent a course of whole-brain and spinal radiotherapy. The patient was followed up for more than half a year and remained in a good condition. The present study describes the two cases and a comprehensive review of the literature that was performed to identify similar studies that document choriocarcinomas in males.
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Affiliation(s)
- Jianyi Guo
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
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Waseda Y, Komai Y, Yano A, Fujii Y, Noguchi N, Kihara K. Pathological complete response and two-year disease-free survival in a primary gastric choriocarcinoma patient with advanced liver metastases treated with germ cell tumor-based chemotherapy: a case report. Jpn J Clin Oncol 2012; 42:1197-201. [PMID: 23071288 DOI: 10.1093/jjco/hys164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Choriocarcinoma is an early metastasizing and highly invasive tumor and characterized as a high-level human chorionic gonadotropin-secreting tumor. It normally arises in the gestational trophoblast, gonads and much less frequently in the stomach. Primary gastric choriocarcinoma appears to have a poor prognosis; especially with liver metastasis, the survival period is expected to be <1 month. This unfavorable clinical outcome is partly due to the lack of defined chemotherapy against primary gastric choriocarcinoma. We herein report a case of a 68-year-old male primary gastric choriocarcinoma patient with advanced liver metastases in which germ cell tumor-based chemotherapy achieved a pathological complete response and 2-year disease-free survival.
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Affiliation(s)
- Yuma Waseda
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba 277-8577, Japan
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32
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Martínez-Ordaz JL, Gómez-Jiménez LM, Ballinas-Oseguera G. [Jejunal metastasis from choriocarcinoma. A three-case report]. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2012; 77:143-7. [PMID: 22921206 DOI: 10.1016/j.rgmx.2012.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 03/29/2012] [Accepted: 03/30/2012] [Indexed: 01/29/2023]
Abstract
Five per cent of patients presenting with choriocarcinoma develop small bowel metastasis. Tumors of the small bowel are rare and the metastases are generally from lung and breast carcinoma or from melanoma. Clinical presentation is vague and the majority of cases are autopsy findings. The main symptoms are related to the presence of abdominal tumor or hemorrhage, or bowel obstruction or perforation. We present the cases of three patients with small bowel metastasis from choriocarcinoma. A 24-year-old woman with bowel obstruction secondary to intussusception caused by a metastatic choriocarcinoma polypoid mass and two men, one 18 years old and the other 24 years old, with a history of testicular tumor, who presented with gastrointestinal bleeding due to small bowel metastasis from choriocarcinoma, 2 and 10 months after orchiectomy, respectively. Management was endoscopic in one case and surgical in the other two. Two patients died in the early postoperative period and one patient died during the first year of follow-up. Choriocarcinoma metastases are very rare and their main clinical manifestations are hemorrhage and bowel obstruction. Management can be either medical or surgical. The majority of patients with choriocarcinoma respond to chemotherapy but prognosis is worse for those patients presenting with small bowel metastasis.
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Affiliation(s)
- J L Martínez-Ordaz
- Servicio de Gastrocirugía, Hospital de Especialidades de Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México DF, México.
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Ji YI, Jung MH. Gastrointestinal bleeding caused by ileal metastasis of a tubal complete mole: a case report. J Womens Health (Larchmt) 2010; 19:1217-20. [PMID: 20392142 DOI: 10.1089/jwh.2009.1685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tubal hydatidiform mole is known to be an extremely rare disease, moreover, gastrointestinal metastasis from an ectopic complete mole has never been reported. MATERIALS AND METHODS A 33-year-old woman presented with gastrointestinal bleeding. She had undergone laparoscopic left salpingectomy for a tubal complete mole a month earlier. An ileal invasion of mole was identified. The patient received nine cycles of adjuvant methotrexate chemotherapy after small bowel resection and anastomosis. She was been without recurrence 20 months after therapy. DISCUSSION Gestational trophoblastic diseases in ectopic pregnancy are rare and gastrointestinal tract metastasis is very infrequent. There have been a few case reports of choriocarcinoma presenting gastrointestinal tract metastasis. To our knowledge, this is the first report of molar pregnancy in a Fallopian tube with ileal metastasis. CONCLUSION Ectopic molar pregnancy with gastrointestinal metastasis carries a high risk of intestinal perforation and uncontrollable gastrointestinal bleeding. Despite its rarity, gastrointestinal metastasis should nevertheless be considered a possible cause for gastrointestinal bleeding in ectopic molar pregnancy patients after elimination of the more common etiologies.
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Affiliation(s)
- Yong-Il Ji
- Department of Obstetrics and Gynecology, School of Medicine, Inje University, Haeundaepaik Hospital, Busan, Korea
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34
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Lee SC, Kim KH, Kim SH, Lee NS, Park HS, Won JH. Mixed testicular germ cell tumor presenting as metastatic pure choriocarcinoma involving multiple lung metastases that was effectively treated with high-dose chemotherapy. Cancer Res Treat 2009; 41:229-32. [PMID: 20057969 DOI: 10.4143/crt.2009.41.4.229] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Accepted: 06/28/2009] [Indexed: 11/21/2022] Open
Abstract
Choriocarcinoma in the testis is very rare, and it represents less than 1% (0.3%) of all the testicular germ cell tumors. It is a particularly aggressive variant of non-seminoma tumor, which is characterized by a high serum beta-HCG level and multiple lung metastases. The optimal management for this disease remains undefined. We report here on a case of choriocarcinoma with multiple lung metastases, and the patient has achieved continuous remission for 2 years after combination chemotherapy of BEP (bleomycin, etoposide and cisplatin) and sequential high-dose chemotherapy with autologous peripheral stem cell rescue.
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Affiliation(s)
- Sang-Cheol Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
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