SESSION TITLE: Cancer Student/Resident Case Report Posters I
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM
INTRODUCTION: Choriocarcinoma is a malignant germ cell tumor.It can present in a gonadal site or, rarely, in extragonadal sites. PPC in a male is an extremely uncommon variant.
CASE PRESENTATION: A 33 year old male with no past history, presented with left sided rib pain. Physical exam revealed tenderness of the left chest wall. Basic labs were normal. Chest X-ray revealed severe bullous disease in the apices and small bilateral pulmonary nodules. At this point a CT thorax showed a low density mass in the left suprahilar region with bilateral pulmonary nodules and emphysema. Radiology did not reveal signs of malignancy elsewhere. A bronchoscopic guided biopsy of a lung nodule was done to arrive at a diagnosis. The biopsy showed a poorly differentiated malignant tumor present within lung parenchyma in sheets with pleomorphism,necrosis and hemorrhage. Multinucleated giant cells resembling syncytiotrophoblast were focally present. The neoplastic cells were positive for keratinAE1/AE3 ,B-hCG and focally for p63. They were negative for alpha-fetoprotein,PLAP and CK5/6. The presence of extensive necrosis and hemorrhage,syncytiotrophoblast-like cells and the strong beta HCG staining supported a diagnosis of choriocarcinoma. The patient’s B-hCG level at time of diagnosis was 30039 mU/ml. Patient was treated with chemotherapy by the oncology service. At the time of discharge the B-hCG had dropped to 25321 mU/ml. At the end of chemotherapy B-hCG levels normalized and an interval CT Thorax after 1.5 months revealed an interval decrease in size of the left upper lobe mass and decrease in the size of pulmonary nodules.
DISCUSSION: PPC is very rare and when it does occur, it is usually in the mid-line structures, mainly the retroperitoneum, mediastinum, or cranial cavity, although other sites have been reported. One of the least common sites is the lung. Treatment is the same as for non-small cell lung cancer. Surgery alone has not been associated with long survival, so chemotherapy is indicated whether or not surgery has been performed. Measurement of β-hCG production is useful for diagnosis, followup, and prognosis of this tumor. A return to normal β-hCG levels after therapy is indicative of good response, and increasing levels may point to recurrence.
CONCLUSIONS: Primary pulmonary choriocarcinoma is a rare diease with a poor prognosis. Final diagnosis can only be made after 'extrapulmonary' disease has been ruled out and confirmation of primary pulmonary diagnosis is made by biopsy and positive B Hcg. Treatment is surgical + adjuvant chemotherapy, but prognosis remains poor.
Reference #1: Serno J,Zeppernick F,Jäkel J,Schrading S,Maass N,Meinhold-Heerlein I,Bauerschlag DO. Primary pulmonary choriocarcinoma: case report and review of the literature. Gynecol Obstet Invest. 2012;74(2):171-6.
Reference #2: Vegh GL,Szigetvári I,Soltesz I,Major K, Batorfi J,Dancso J,Zsirai L,Fulop V. Primary pulmonary choriocarcinoma: a case report. J Reprod Med. 2008 May;53(5):369-72.
DISCLOSURE: The following authors have nothing to disclose: Aakash Aggarwal, Emerald Banas, Badal Kalamkar, Sam Benjamin
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