Primary choriocarcinoma in mediastinum with multiple lung metastases in a male patient: A case report and a review of the literature

Abstract

Primary choriocarcinoma is a rare malignant tumor, particularly in men. The tumor, mostly found in the gastrointestinal system and mediastinum, often metastasizes early with poor therapeutic effects and prognosis. Herein, we present a male patient with primary mediastinum choriocarcinoma and widespread lung metastases. The disease progressed rapidly with little therapeutic effect from chemotherapy. The patient died of this disease 75 days after initial symptom presentations. Literature review found only 41 cases of primary choriocarcinoma reported in the mediastinum. This case highlights the importance of keeping primary choriocarcinoma in the differentials for mediastinum tumors in young men. Sex hormone testing is helpful to confirm diagnosis. Early biopsy should be performed to confirm pathologic diagnose, and early surgery and chemotherapy should be considered to improve the cure rate of this disease. Case reportA 20 year old male presented with paroxysmal cough, expectoration of phlegm, minor fresh red hemoptysis, fever, and chest distress and pain for two weeks on 25 May 2011. Contrast-enhanced computed tomography (CT) showed a huge borderless mass in the anterior mediastinum, with low density in the central and marked enhancement in the surrounding area; diffuse oval nodules with peripheral enhancement in bilateral lungs; and enlargement of multiple mediastinal lymph nodes (Fig 1).The patient was lassitude with mild cyanosis. No superficial lymph node enlargement was found. Clear harsh breath sounds were heard in both lungs, with mild moist rales in the right lower lung. No abnormal signs were observed in the heart, abdomen, genital system or neural system. Auxiliary examination results showed: Blood-Rt: white blood cell: 17.32 × 10 9 /L; neutrophil percentage: 75.8%; hemoglobin: 139g/L; Urine-Rt: red blood cell: 5.5/heterogeneous packet flows; protein: 1 + ; tumor markers: CA12-5 56.03 U/mL (normal value: 0-39 U/mL), CYFRA21-1 50.77 ng/mL (normal value: 1-3.3 ng/mL), NSE 19.93 ng/mL (normal value: 0-16.3 ng/mL) were all elevated significantly, and the carcinoembryonic antigen (CEA) level was normal; coagulation tests (5 items): D-dimer: 666 ug/L, FIB: 4.57g/L; and the biochemical test for liver function was normal. The abdominal ultrasound and CT scan were normal. The preliminary diagnosis was a mediastinal tumor with multiple lung metastases. B-ultrasound examination was performed to exclude the primary tumor from other sites, including bilateral testes, and all were negative. Ultrasound guided percutaneous needle biopsy of the mediastinal mass was performed and the cytologic examination showed few marked dyskaryotic cells, but only hemorrhagic necrosis tissue with some keratinized material was seen in histology (Figs 2, 3).The second ultrasound guided percutaneous needle biopsy from both the mediastinal mass and a metastatic lesion in the right lung was performed on 7 June 2011 and a clear pathological diagnosis was obtained as mediastinum chorionic epithelioma with lung metastasis. The immunoh...

Incidence and prognosis factors of extragonadal choriocarcinoma in males: a population-based study

“…For example, the primary mediastinal choriocarcinoma was first described by Arendt in 1931, and only 43 subsequent reports were found by 2014. 3 Zhu et al’s literature review of primary pulmonary choriocarcinoma in males reflected only 29 cases reported by 2016. 5 In our study, the incidence of extragonadal choriocarcinoma in males estimated by SEER data was 0.022/100,000 people, and the incidence decreased from 1981.…”

“…These findings are in agreement with a literature review involving 41 cases of primary mediastinal choriocarcinoma, which is usually diagnosed in young patients aged between 20 and 30 years old. 3 However, 26 cases of primary choriocarcinoma of the bladder and 53 cases of primary gastric choriocarcinoma reported in the literature showed that the majority of patients were diagnosed at 50+ years of age, and Serno et al found that the median age of male primary pulmonary choriocarcinoma was 60 years. 6 , 21 , 22 Therefore, we speculate that choriocarcinoma at midline locations mainly occurs in young patients, while choriocarcinoma of parenchymal organs tends to affect older patients.…”

Incidental primary mediastinal choriocarcinoma diagnosed by endobronchial ultrasound‐guided fine needle aspiration in a patient presenting with transient ischemic attack and stroke

“…Cases of gestational, gonadal nongestational, or extragonadal primary choriocarcinomas in the liver, kidney, lung, or brain presenting with neurological impairment compatible with brain metastasis with intracranial hemorrhage have been reported . However, primary mediastinal choriocarcinoma is rare, and most often presents with symptoms such as coughing and chest pain . It is exceedingly rare for a primary mediastinal choriocarcinoma to present as TIA or stroke, as reported for this patient.…”

“…[18][19][20][21][22] However, primary mediastinal choriocarcinoma is rare, and most often presents with symptoms such as coughing and chest pain. 21,[23][24][25][26] It is exceedingly rare for a primary mediastinal choriocarcinoma to present as TIA or stroke, as reported for this patient. The posterior mediastinal location of this tumor is also very unusual, since most GCTs are typically found in the anterior aspect.…”

Primary mediastinal choriocarcinoma in a female patient: Case report and review of the literature

“…The mechanism by which primary mediastinal non-gestational choriocarcinoma develops is poorly understood. Postulated theories include: (1) metastases from a primary gonadal choriocarcinoma that regressed spontaneously; (2) origin from a trophoblastic embolus related to a gestational event after a long period of latency; or (3) origin from retained primordial germ cells that migrated abnormally during embryogenesis ( Fine et al, 1962 ; Br Med, 1969 ; Cohen and Needle, 1975 ; Forest et al, 1977 ; Lam et al, 2011 ; Zhang et al, 2014a ; 2014b ; Kuno et al, 2016 ; Zhang et al, 2016 ; Francischetti et al, 2017 ).…”