Primary gastric choriocarcinoma: two case reports and a pooled analysis of 53 cases

Abstract

rameters of PGCs were described in some of these reports, most of the conclusions were unreliable because of the small number of PGC cases analyzed.In the present study, we conducted a pooled analysis of 53 PGC cases, including 2 patients treated at the National Cancer Center Hospital East (NCCHE), to clarify the tumor characteristics and prognostic parameters of patients with PGC. Case reports Case 1A 74-year-old man complaining of loss of appetite and loss of body weight, for 9 months, visited the NCCHE. Laboratory data showed anemia (RBC, 369 ¥ 10 4 /mm 3 ; hemoglobin [Hb], 8.4 g/dl; hematocrit [Hct], 28.5%), hypoalbuminemia (serum albumin, 3.0 g/dl), and high serum carcinoembryonic antigen (CEA; 31.2 ng/ml; normal, 0-5 ng/ml).A gastrointestinal X-ray examination revealed an ulcerated lesion with a distinct elevation occupying the lower third of the stomach and invading the duodenum. The lesion was endoscopically diagnosed as a gastric cancer, and a biopsy specimen taken from its margin revealed well-differentiated tubular adenocarcinoma. A computed tomography (CT) scan and echography showed no evidence of liver metastasis at this time.A radical subtotal Billroth II gastrectomy with lymph node dissection, omentectomy, and partial resection of the pancreatic head was performed. Macroscopically, no signs of liver metastasis or retroperitoneal invasion were observed.The resected tumor was 11.5 ¥ 8.5 ¥ 5.0 cm in size. The tumor had extended to the serosa (T3) and had directly invaded the duodenum. A metastasis was found in one of the supragastric lymph nodes (N1). Grossly, the tumor was fungating (Fig. 1). Histologically, the tumor Abstract Primary gastric choriocarcinoma (PGC) is a rare tumor. In total, approximately 140 cases of PGC have been reported in the international medical literature. However, the clinical behavior, tumor characteristics, and prognostic parameters of PGC have not been clearly described. We conducted a pooled analysis to clarify the tumor characteristics and prognostic parameters in 53 patients with PGCs, including 2 patients treated at our hospital. The following variables were examined as potential prognostic factors: (1) sex, (2) age, (3) depth of invasion, (4) size, (5) histology, (6) nodal metastasis, (7) distant lymph node metastasis, (8) synchronous liver metastasis, (9) residual tumor, and (10) chemotherapy (not given or given). Univariate and multivariate analyses showed that the presence of residual tumor and synchronous liver metastasis and the absence of chemotherapy were significantly associated with an increased hazard rate (HR) of short overall survival (OS). Pooled analysis, including the two patients with PGC treated at our facility, demonstrated that the presence of a curative operation and chemotherapy, and the absence of synchronous liver metastasis were the strongest indicators of a favorable clinical course in patients with PGC.

Primary Choriocarcinoma of the Stomach. A Case Report and Review of the Literature

“…Most cases show metastasis at the time of presentation and the most common sites of metastasis are lymph nodes followed by liver, peritoneum and lungs. In our case, there was no evidence of metastasis at presentation [6].…”

“…Kobayashi et al performed a pooled analysis of 53 patients reported in the literature so far with PGC and described a male to female ratio of 2.3:1 with a median age at presentation of 63 years. Lower third of the stomach was found to be the most frequent location of PGC [6].…”

“…In our case survival period was only 5 months. The most common cause of death is liver failure secondary to metastasis [6].…”

Gastric choriocarcinoma admixed with an α-fetoprotein-producing adenocarcinoma and separated adenocarcinoma

“…It often arises in the uterus in association with pregnancy, and its most common extragonadal sites are the mediastinum, ovary and testis [1] . Primary gastric choriocarcinoma (PGC) is a rare neoplasm that constitutes less than 1% of all gastric cancers [2] . It was first described by Davidsohn in 1905 and more than 140 cases have been reported in the international medical literature.…”

Combined choriocarcinoma, neuroendocrine cell carcinoma and tubular adenocarcinoma in the stomach

“…Primary carcinoma of the stomach is almost always adenocarcinoma or signet ring cell carcinoma and there have been few reports of choriocarcinoma [1][2][3][4][5] or neuroendocrine cell carcinoma [6][7][8][9] . We report a patient with adenocarcinoma of the stomach combined with choriocarcinoma and neuroendocrine cell carcinoma.…”