Aspiration biopsy cytomorphology of primary pulmonary germ cell tumor metastatic to the brain

Abstract

Extragonadal germ cell tumors are uncommon and such tumors originating from the lung parenchyma are extremely rare. This is a case of 68-year-old female who was admitted with complaints of right-sided weakness, inability to maintain her balance, right-sided headache, and bloody sputum. Her workup revealed two enhancing brain lesions and large lung mass involving the left lower lobe. Fine-needle aspiration (FNA) of the lung followed by craniotomy was performed and the patient was initially diagnosed with lung adenocarcinoma metastatic to the brain based on the cytomorphology of the lung FNA and histology of the brain mass. However, retrospective investigation revealed markedly elevated alpha fetoprotein (AFP) of which the cytopathologist was unaware at the time of diagnosis. A review of the cytology and surgical specimen slides, as well as immunohistochemistry (IHC) on the brain tumor and FNA cell block were preformed. On the basis of the slides review, clinical findings, and immunostaining results, a diagnosis of primary pulmonary mixed germ cell tumor, containing choriocarcinoma and yolk sac elements, with brain metastases, was retrospectively made.

Primary Embryonal Lung Carcinoma and Testicular Seminoma in the Same Patient Ten-Years Later: Case-Report and Literature Review

“…Both may have similar cellular arrangements and similar cytomorphology. Both can show a background of tumor necrosis, as in our case [9].…”

“…In the same year, Vaideeswar et al reported seven cases of PPC seen in autopsy and surgical materials [8]. Four additional cases were found in a review by Arabi and collegues [9]. In our review of the literature to date, we found four additional cases of PPC [10].…”

Human choriocarcinomas: Placental growth factor-dependent preclinical tumor models

“…JEG-3 tumors grew the fastest and reached ~1500 mm 3 in volume in 15 days compared to ~19 and 26 days for JAR and BeWo tumors respectively (Fig. 3A).…”

“…The increase in median survival of mice bearing the JEG-3 xenograft was modest with a median survival of 22 days for the control group and 27 days for the sFLT01 treatment group. sFLT01 (25 mg/kg) was more active in the JAR model resulting in 18 days of tumor growth delay determined when the mean tumor volumes reached ~1000 mm 3 (Fig. 6B).…”

“…Choriocarcinoma is a gestational trophoblastic disease that often, but not always, appears within one year antecedent pregnancy and can be treated by surgery or by standard cytotoxic chemotherapeutic drugs (2). Published case reports of metastatic choriocarcinomas are not uncommon (1,(3)(4)(5).…”