Choriocarcinoma Presenting as a Pleural Effusion

Abstract

Choriocarcinoma is a germ cell tumor characterized by widespread metastases and poorly differentiated cells. Non-gestational choriocarcinoma, or primary choriocarcinoma is a trophoblastic disease which is associated with a poor patient prognosis and is markedly angioinvasive. Primary non-gestational mediastinal choriocarcinoma is a very rare disease and represents an aggressive malignancy, primarily seen in young males. Those with primary mediastinal choriocarcinoma have symptoms that are non-specific such as cough, dyspnea, hemoptysis, and chest pain. Here we present the case of a 47-year-old Caucasian female who presented with worsening dyspnea and cough. Laboratory testing revealed elevated alkaline phosphatase, human chorionic gonadotropin, and cancer antigen 125. Chest X-ray was significant for a large right pleural effusion and a computed tomography angiogram of the chest showed a soft tissue mass in the anterior medial right lung base/right middle lobe. Thoracentesis yielded results consistent with malignant cells favoring a germ cell tumor. Biopsy of the mediastinal mass revealed positivity for inhibin and both human chorionic gonadotropin and CD-10 which led to the diagnosis of primary choriocarcinoma. Primary mediastinal choriocarcinoma is uncommon and often has a non-specific clinical presentation. A high degree of suspicion is needed as this malignancy can be aggressive, necessitating urgent definitive tissue biopsy diagnosis to guide appropriate therapy.

Pembrolizumab for treatment of a male with primary mediastinal choriocarcinoma: a case report

“…PCC is a rare trophoblastic tumor that can occur in both sexes. PCC of the mediastinum is even rarer, with less than 50 cases reported since it was first reported in 1931 until 2022 (3,(6)(7)(8)(9)(10). The clinical symptoms are atypical, including chest pain, cough, hemoptysis, short of breath, and weakness.…”

Primary non-gestational mediastinal choriocarcinoma metastatic to the brainstem

“…The magnetic resonance spectroscopy findings disclosed a midbrain tumour with necrosis similar to the mediastinal mass findings. Primary extragonadal non-gestational mediastinal choriocarcinoma is a highly aggressive tumour primarily seen in young men associated with a poor prognosis 1–4 8–12. Patients with primary mediastinal germ cell tumours fare worse than those with tumours at other locations 1 8 9 11 13–17.…”

“…Primary extragonadal non-gestational mediastinal choriocarcinoma is a highly aggressive tumour primarily seen in young men associated with a poor prognosis 1–4 8–12. Patients with primary mediastinal germ cell tumours fare worse than those with tumours at other locations 1 8 9 11 13–17. Malignant germ cell tumours emerge from a totipotent cell; thus, accounting for the wide variety of primary anatomic sites, including gonadal, sacrococcygeal, mediastinal, retroperitoneal and other paraxial locations 18.…”

“…Upfront resection of the mediastinal mass should only be attempted in those cases with normal serum markers and if the resection can be performed completely without removing adjoining organs 18. For primary non-gestational mediastinal choriocarcinoma, the diagnosis relies on radiological examinations followed by biopsy and histochemical staining 8. In patients with intra-axial brain lesions, contrast-enhanced brain MRI FLAIR images provide better neuroradiological anatomic descriptions 25 26.…”