Lung Cancer: Student/Resident Case Report Poster - Lung Cancer II |

Primary Pulmonary Choriocarcinoma: A Case Report FREE TO VIEW

Robert Chiaruttini, DO; Michael Switzer, DO
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Walter Reed National Military Medical Center, North Bethesda, MD

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):766A. doi:10.1016/j.chest.2016.08.861
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SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer II

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: A form of Gestational Trophoblastic Disease, Choriocarcinoma is a highly malignant and invasive ovarian tumor classically associated with pregnancy. Primary pulmonary choriocarcinoma is a rare form of this disease with only 32 reported in the medical literature since 1958.

CASE PRESENTATION: 55 y/o female initially seen at an outpatient clinic with productive cough of dark colored mucus, chills, and sweats for 1 week. She was a 40 pack-year smoker with remote history of hysterectomy. She was seen as an outpatient 3 times over 6 weeks, by 3 different physicians, for persistent symptoms despite treatment for a diagnosis of bronchitis then asthma despite no prior history of asthma and functional testing. None of the 3 physicians were her actual primary care doctor and one of these visits was to an urgent care clinic that didn’t have access to previous medical records. There was a clear chest x-ray on the initial visit and a reportedly normal chest x-ray at the urgent care clinic visit with no report of objective findings on physical exam at any visit. 8 weeks after the initial appointment, an x-ray at another primary care appointment showed small bilateral pulmonary nodules prompting further evaluation. Repeat chest x-ray one week later showed marked increase in size and number of bilateral pulmonary nodules. Over the next 3 weeks, the patient failed to return for subsequent scheduled appointments and was admitted to the hospital for expedited evaluation after later returning to the pulmonology clinic with worsening symptoms. On admission numerous, bilateral, pulmonary cannonball lesions and an elevated B-Hcg were found. Biopsy of these lesions showed choriocarcinoma. Comprehensive imaging to include a PET showed no other primary lesions. Chemotherapy treatment was started with subsequent decrease in her B-Hcg. Despite this treatment and initial improvement, she developed neurological symptoms and was found to have metastasis to her brain. She requested palliative treatment and hospice.

DISCUSSION: Primary pulmonary choriocarcinoma is an extremely rare disease with rapid progression and poor clinical outcome. It is unknown if earlier intervention in this patient would have changed the outcome. This case demonstrates the importance of vigilance in the primary care setting to identify patients who repeatedly present with persistent symptoms despite appropriate treatment for their presumed diagnosis. This is especially important in patients seen by different providers in different outpatient clinics.

CONCLUSIONS: In the often overworked primary care setting it is easy to focus on an anchored diagnosis and miss important elements of an initial assessment. Vigilance is important in primary care especially when patients are receiving care from other modalities that have limited to no communication with each other.

Reference #1: Serno, J. et al. Primary pulmonary choriocarcinoma: case report and review of the literature. Gynecol Obstet Invest. 2012;74(2):171-6.

DISCLOSURE: The following authors have nothing to disclose: Robert Chiaruttini, Michael Switzer

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