Choriocarcinoma syndrome after resection of primary pulmonary choriocarcinoma: report of a case

Abstract

BackgroundChoriocarcinoma syndrome is known as a lethal complication from tumoral hemorrhage, which frequently occurs at the site of tumor metastasis.Case presentationA 59-year-old man with 60-pack-year smoking history was referred to our hospital because of hemoptysis. Chest computed tomography (CT) showed a 28 × 18 mm spiculated nodule with a cavity infiltrating the left upper lobe. A transbronchial lung biopsy was performed, and histopathological examinations revealed adenocarcinoma. No distant or regional metastasis was observed, and therefore, the patient underwent a left upper lobectomy with lymphadenectomy. Histological examinations showed that the tumor consisted of poorly differentiated adenocarcinoma cells and a choriocarcinomatous component; no multiple pulmonary metastases and mediastinal lymph node metastasis were observed. Immunohistochemical analysis showed a positive immunoreaction for human chorionic gonadotropin in the syncytiotrophoblastic cells of the choriocarcinoma. One month after the operation, the patient developed massive hemoptysis. CT showed diffuse alveolar infiltration in both the lungs. A bronchoscopic examination showed bleeding from the right upper bronchus. Aspiration cytology showed carcinoma. Despite blood transfusion and management in the intensive care unit, the patient died one and a half month after diagnosis.ConclusionsWe herein report a case of a man who developed choriocarcinoma syndrome 1 month after resection for combined choriocarcinoma and adenocarcinoma of the lung. Choriocarcinoma syndrome is a rare and life-threatening complication which may occur in patients with primary pulmonary choriocarcinoma. However, we need to consider the risk of this syndrome while dealing with patients who have massive hemoptysis.

Case of acute respiratory distress syndrome in a patient with an extragonadal germ cell tumor without lung metastasis in which choriocarcinoma syndrome was suspected

“…In addition, Takahashi et al . reported that they resected lung lesions with choriocarcinoma components, and ARDS occurred 1 month after the resection procedure despite the removal of the primary lesion . These cases suggest that choriocarcinoma syndrome is not simply caused by bleeding from metastatic lesions, but rather might be caused by cytokine release associated with tumor lysis.…”

Acute pulmonary hemorrhage associated with metastatic testicular choriocarcinoma in a 46-year-old incarcerated male

“…CS is more likely with higher levels of bHCG. [7] The most common presentation of CS is pulmonary hemorrhage, but hemorrhage can develop in the liver, brain, and small bowel as well. Hemorrhage can occur immediately following chemotherapy, or present as the initial primary complaint.…”

When a Differential Diagnosis Is Fundamental: Choriocarcinoma Mimicking Lung Carcinoma

“…Among the different choriocarcinoma distant recurrence sites, the lung is the most frequent site for metastasis and is associated with lethal hemorrhagic complications [1]. Indeed, in the published literature, the prognosis is reported as poor due to the rapidity of tumor growth and association of bleeding risk with surgery, barotrauma, and acute respiratory distress syndrome.…”

“…Choriocarcinoma is a very rare malignant disease that is usually associated with a gestational event, such as hydatidiform mole, spontaneous abortion, or ectopic pregnancy [1]. Non-gestational choriocarcinoma is remarkably rare, arising from pluripotent germ cells in the gonads or midline structures, such as the mediastinum [2].…”