Primary gastric choriocarcinoma - a rare and aggressive tumor with multilineage differentiation: A case report

Abstract

BACKGROUND Primary choriocarcinoma of the stomach (PCCS) is a rare tumor, with fewer than 60 cases published in the English-language literature up to December 2018. In this paper, we present the complex immunoprofile of one PCCS and a hypothesis regarding its histogenesis. CASE SUMMARY A 66-year-old previously healthy male underwent an emergency palliative gastrectomy for a gastric obstructive tumor. The histologic examination and immunoprofile of tumor cells showed a mixed tumor that consisted of choriocarcinoma (90%) and moderate differentiated adenocarcinoma (10%), with hepatic metastases (Stage pT2NxM1L1V1R0) and microsatelite stable status. The patient died one month after surgery. The tumor cells showed focal positivity for CDX2 (adenocarcinoma component), HCG (choriocarcinoma) and CD138 (plasmacytoid carcinoma component) and were negative for HER-2, α-fetoprotein, VEGF, maspin and markers of epithelial-mesenchymal transition. The gastric mucosa cells displayed positivity for CDX2, Hepar A and CD138. The complex immunoprofile and literature data synthesis prove that the gastric mucosa cells can present a multilineage differentiation. CONCLUSION PCCS should be considered as an aggressive variant of microsatellite stable gastric adenocarcinoma of an epithelial type, and not a germ cell tumor.

Clinical features of a Chinese female nongestational choriocarcinoma cohort: a retrospective study of 37 patients

“…Liver, brain, pelvic and abdominal metastases were present only in limited cases. This metastasis pattern is consistent with this study and our former research [4]. Some studies have shown that mixed type NGCs seem to have relatively poor prognosis [1].…”

“…Our study showed that mixed type and pure type NGCs exhibited similar CR and survival rates. Moreover, the overall prognosis of NGC was good, and the 5-year survival rate was still high, similar to our former study of 79.4% [4].…”

“…Standardization of reporting results of cancer treatment and our former study [4,13]: complete response (CR), partial response (PR), progressive disease (PD) and relapse. CR was de ned as complete elimination of all clinical syndromes and no laboratory or imaging abnormalities for at least four weeks.…”

“…To the best of our knowledge, there has been no report of a NGC cohort from another medical center except for our previously reported clinical analysis of 21 nongestational ovarian choriocarcinomas in 2009 [4]. Our previous study on cases from March 1982 to October 2008 indicated that the rates of complete remission and 5-year overall survival were 76.2% and 79.4%, respectively.…”

“…Owing to the rarity of NGC, its clinical characteristics remain unclear, and the symptoms are often nonspeci c. Abnormal uterine bleeding, abdominal pain, endocrine disorders, detection of a pelvic mass and precocious puberty have been previously reported [4,5]. Germ cell tumor NGCs occur in the ovaries and midline locations, such as the mediastinum, retroperitoneum, and pineal gland.…”