1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Primary Mediastinal Germ Cell Tumors-The University of Western Ontario Experience. ACTA ACUST UNITED AC 2020; 28:78-85. [PMID: 33704177 PMCID: PMC7816187 DOI: 10.3390/curroncol28010010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022]
Abstract
Extragonadal germ cell tumors account for 2–5.7% of germ cell tumors (GCTs). Of these, primary mediastinal GCTs (PMGCTs) are responsible for 16–36% of cases. Given the rarity of these tumors, specific treatment strategies have not been well defined. We report our experience in treating these complex patients. In total, 318 men treated at our institution with chemotherapy for GCTs between 1980 and 2016 were reviewed. PMGCT was defined as clinically diagnosed mediastinal GCT with no evidence of testicular GCT (physical exam/ultrasound). We identified nine patients diagnosed with PMGCT. All patients presented with an anterior mediastinal mass and no gonadal lesion; four patients also had metastatic disease. Median age at diagnosis was 30 years (range, 14–56) and median mass size at diagnosis was 9 cm (range, 3.4–19). Eight patients had non-seminoma and one had pure seminoma. All patients received cisplatin-based chemotherapy initially. Surgical resection was performed in four patients; three patients had a complete resection and one patient was found to have an unresectable tumor. At a median follow-up of 2 years (range, 3 months–28 years) six patients had progressed. Progression-free survival was short with a median of 4.1 months from diagnosis (range 1.5–122.2 months). Five patients died at a median of 4.4 months from diagnosis. One and 5-year overall survivals were 50% and 38%, respectively. PMGCT are rare and aggressive. Our real-life Canadian experience is consistent with current literature suggesting that non-seminoma PMGCT has a poor prognosis despite prompt cisplatin-based chemotherapy followed by aggressive thoracic surgery.
Collapse
|
4
|
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.
Collapse
|
5
|
Batman S, Morgan T, Brunetti M, Strandabø RAU, Micci F, Moffitt M, Pejovic T. Primary mediastinal choriocarcinoma in a female patient: Case report and review of the literature. Gynecol Oncol Rep 2018; 26:99-101. [PMID: 30456287 PMCID: PMC6232631 DOI: 10.1016/j.gore.2018.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/26/2018] [Accepted: 10/28/2018] [Indexed: 11/15/2022] Open
Abstract
Primary mediastinal choriocarcinoma is rare, especially in female patients. Genomic losses predominated our case, which has not been previously reported. This tumor lacked human chorionic gonadotropin and required histologic diagnosis.
Collapse
Affiliation(s)
- Samantha Batman
- Department of Obstetrics and Gynecology, Oregon Health &Science University, Portland, Oregon, USA
| | - Terry Morgan
- Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Marta Brunetti
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital, Radium Hospital, 0310 Oslo, Norway
| | - Rønnaug A U Strandabø
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital, Radium Hospital, 0310 Oslo, Norway
| | - Francesca Micci
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital, Radium Hospital, 0310 Oslo, Norway
| | - Melissa Moffitt
- Department of Obstetrics and Gynecology, Oregon Health &Science University, Portland, Oregon, USA
| | - Tanja Pejovic
- Department of Obstetrics and Gynecology, Oregon Health &Science University, Portland, Oregon, USA
| |
Collapse
|
6
|
Francischetti IMB, Cajigas A, Suhrland M, Farinhas JM, Khader S. Incidental primary mediastinal choriocarcinoma diagnosed by endobronchial ultrasound-guided fine needle aspiration in a patient presenting with transient ischemic attack and stroke. Diagn Cytopathol 2017; 45:738-743. [PMID: 28397369 DOI: 10.1002/dc.23719] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/24/2017] [Indexed: 12/27/2022]
Abstract
We describe a case of a 41-year old male patient with no significant prior medical history who presents with symptoms of Transient Ischemic Attack and stroke. Magnetic Resonance Imaging (MRI) of the brain identified areas of ischemia in the left side, and angiography showed occlusion of the left Medial Cerebral Artery (MCA). Cardiac Transthoracic Echocardiogram (TTE) for stroke evaluation incidentally noted a mediastinal abnormality leading to cancer work-up. Computer Tomography (CT) and 18 F-fluorodeoxyglucose (FDG) PET-CT scan of the chest incidentally revealed an avid 6 cm paraesophagial/subcarinal mass. Further diagnostic work-up with endoscopic and endobronchial ultra sound (EBUS)-guided fine needle aspiration (FNA) of the mass yielded a cytology diagnosis of Germ Cell Tumor (GCT), with choriocarcinoma component. Additionally, high plasma levels of β-human chorionic gonadotrophin (β-HCG) were detected with no evidence of testicular tumor. This exceedingly rare presentation for a primary mediastinal choriocarcinoma underscores the importance of complete investigation of young patients presenting with neurological symptoms compatible with ischemic events. Diagn. Cytopathol. 2017;45:738-743. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Ivo M B Francischetti
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Antonio Cajigas
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.,Division of Cytology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Mark Suhrland
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.,Division of Cytology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Joaquim M Farinhas
- Department of NeuroRadiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Samer Khader
- Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.,Division of Cytology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Liu H, Xiao YD, Peng SP, Zhou SK, Liu J. Pituitary metastasis of choriocarcinoma: A case report. Oncol Lett 2016; 11:1517-1520. [PMID: 26893772 DOI: 10.3892/ol.2016.4088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 06/03/2015] [Indexed: 01/09/2023] Open
Abstract
Choriocarcinoma is an aggressive obstetric or gynecological neoplasm with a high malignant potential. It is a form of gestational trophoblastic disease and often secondary to hydatidiform mole, and intrauterine or ectopic pregnancy. Choriocarcinoma has a proclivity to metastasize to the lung, vagina, pelvis or liver in over 50% of patients, which always occurs in the early stage of the disease. With an appropriate amount of chemotherapy, the tumor may be treated effectively. However, pituitary metastasis of choriocarcinoma is extremely rare. To the best of our knowledge, no cases of choriocarcinoma metastasizing to the pituitary have been cited previously. Here, we report a case of choriocarcinoma that presented with pituitary metastasis.
Collapse
Affiliation(s)
- Huan Liu
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Yu-Dong Xiao
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Shu-Ping Peng
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Shun-Ke Zhou
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| |
Collapse
|