• immune checkpoint inhibitors
• ipilimumab
• lung cancer with choriocarcinoma features
• nivolumab
• whole exome sequencing
• whole transcriptome sequencing

• Classification
• Diagnosis
• Pathology

• beta-human chorionic gonadotropin (β-hcg)
• chemotherapy
• choriocarcinoma
• human chorionic gonadotrophin
• intestinal bleeding
• jejunal choriocarcinoma
• oncology
• primary choriocarcinoma
• rebleeding
• surgery

• bloody pleural fluid effusion
• choriocarcinoma
• β‐Human chorionic gonadotropin

• case report
• choriocarcinoma
• pathology
• primary gastric choriocarcinoma
• treatment

Extragonadal choriocarcinoma is rare and can be associated with hyperthyroidism when producing very high levels of human chorionic gonadotropin.

A 62-year-old Hispanic female presented with a 3-week history of shortness of breath, palpitations, extreme weakness, new-onset hot flashes, and right flank pain. Her physical examination was remarkable for tachycardia, hepatomegaly, hyperreflexia, and tremor; goiter was absent. Laboratory studies revealed increased lactate dehydrogenase, alkaline phosphatase, suppressed thyroid stimulating hormone, very elevated T4, and absent thyroid stimulating immunoglobulin. ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography exhibited hepatomegaly with multiple large fluorodeoxyglucose-avid liver masses and a focus of fluorodeoxyglucose avidity in the stomach with no structural correlate. A thyroid scan (^99mTcO₄⁻) showed diffusely increased tracer uptake. She was started on propranolol and methimazole. Upon stabilization of severe thyrotoxicosis, upper endoscopy was performed, showing a ~ 5 cm bleeding lesion in the greater stomach curvature body; biopsy was consistent with choriocarcinoma; beta-human chorionic gonadotropin hormone was 2,408,171 mIU/mL. The patient received methotrexate followed by etoposide and cisplatin. Methimazole was titrated down, and upon liver failure the medication was stopped. The thyrotoxicosis was effectively controlled with antithyroid drug and concurrent chemotherapy. At ~ 1.5 months after initial diagnosis, the patient died due to bleeding/acute liver failure with coagulation defects followed by multiple organ failure.

Severe thyrotoxicosis can represent an unusual initial presentation of metastatic choriocarcinoma in the setting of extreme elevation of beta-human chorionic gonadotropin. Primary gastric choriocarcinoma is an aggressive malignancy with very poor outcomes. The co-occurrence of severe thyrotoxicosis with advanced primary gastric choriocarcinoma and imminent liver failure complicates management options.

• Case report
• Germ cell tumor
• Human chorionic gonadotropin
• Hyperthyroidism
• Paraneoplastic syndrome

Choriocarcinoma is form of malignant neoplasm that arise from trophoblastic cells that occurs mostly in ovaries and testes and it can metastasis to lungs, liver or to gastrointestinal tract.

This is 37 years old female presented as a case of lower gi bleeding and was diagnosed to have metastatic jejunal and ilium choriocarcinoma of unknown primary and underwent ileocecal resection first then followed up with small bowel resection around 60 cm from duodenojejunal junction with primary anastomosis. The patient was found to have liver and brain metastasis and received chemotherapy with full response.

Choriocarcinoma is the most aggressive form of gestational trophoblastic disease that metastasizes through the lymphatic and hematogenous routes, and when its metastasis to the small bowel it's considered the worst prognosis with high mortality rate. Treatment consists of surgery and combined chemotherapy which is what our patient responded with.

Metastatic choriocarcinoma with unknown primary can be treated surgically with chemotherapy.

•

Metastatic choriocarcinoma with unknown origin how to diagnose and treat

• Gastrointestinal choriocarcinoma
• Metastatic choriocarcinoma with unknown origin

• Extragonadal non-trophoblastic choriocarcinoma
• Immunohistochemistry
• Male
• Metastases
• Midline
• Palatine tonsil
• β-Human chorionic gonadotropin

• Primary extragenital choriocarcinoma
• male
• mediastinum

• Gastric cancer
• choriocarcinoma
• gastric adenocarcinoma
• helicobacter pylori
• intestinal metaplasia

• Case report
• Choriocarcinoma
• Gastrointestinal
• Immunohistochemistry
• Maspin
• Stomach

• diffuse metastases
• male choriocarcinoma
• primary mediastinal choriocarcinoma

• Adult
• Choriocarcinoma/diagnosis
• Choriocarcinoma/pathology
• Choriocarcinoma/secondary
• Choriocarcinoma/therapy
• Diagnosis, Differential
• Fatal Outcome
• Humans
• Male
• Mediastinal Neoplasms/diagnosis
• Mediastinal Neoplasms/pathology
• Mediastinal Neoplasms/therapy
• Neoplasm Metastasis

•

A 78-year-old man was diagnosed with stage cIB primary gastric choriocarcinoma.

Primary gastric choriocarcinoma (PGC) is a rare and rapidly invasive tumor. We report a case of PGC diagnosed by endoscopic biopsy and treated with gastrectomy and chemotherapy.

A 78-year-old man was referred to our hospital because esophagogastroduodenoscopy showed a tumor at the fornix of the stomach. Pathologic examination of biopsy specimens revealed choriocarcinoma. Abdominal computed tomography (CT) revealed no enlarged abdominal lymph nodes or distant metastases. Robot-assisted total gastrectomy with spleen-preserving D2 lymphadenectomy was performed on the basis of a diagnosis of cT2N0M0, stage cIB PGC. The pathologic diagnosis was pT2, ly0, v1, pN0, PM0, DM0, stage pIB PGC. The postoperative course was uneventful, and the patient was followed carefully without adjuvant chemotherapy. Three months after gastrectomy, blood tests indicated that serum β-human chorionic gonadotropin (β-hCG) levels had increased, and CT revealed multiple liver metastases. The patient underwent a standard nongestational choriocarcinoma chemotherapy regimen with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine. Although β-hCG levels temporarily decreased with chemotherapy, the patient experienced tumor recurrence with ascites and his serological test demonstrated an elevated level of β-hCG (120 ng/mL). The patient died 10 months postoperatively.

We report a case of stage pIB PGC with poor prognosis, recurring at only 3 months postoperatively despite curative surgery and chemotherapy.

• Primary gastric choriocarcinoma
• Short-term survival
• Total gastrectomy

• Choriocarcinoma
• Gastrointestinal
• Gestational trophoblastic neoplasms
• Immunohistochemistry
• PD-L1

Choriocarcinoma usually occurs in females and sometimes occurs in the testicles of males. Extragonadal choriocarcinoma in males was previously described in case reports, and our understanding of this type of cancer has remained limited. The purpose of this study was to explore the incidence, treatment and prognostic factors of extragonadal choriocarcinoma in males.

Two cohorts were identified from the Surveillance, Epidemiology, and End Results (SEER) Program by histology, tumor site and sex. One cohort of 115 patients was created using the SEER nine registries (1973–2014) to estimate the incidence. The other cohort of 197 patients was created using the SEER 18 registries (1973–2013) to estimate the patient demographics and survival.

The median age at diagnosis was 30 years. The most common primary tumor location was the mediastinum followed by the retroperitoneum and the brain. Approximately 23% of patients underwent beam radiation therapy, whereas 63.5% underwent surgery. The estimated one- and 5-year cause-specific survival rates were 49% and 35%, respectively. The multivariate analysis showed that the age at diagnosis, ie, a younger age of 0–19 years old, and the primary tumor site, ie, the brain, were the independent prognostic factors and were correlated with a favorable prognosis. The median survival time of patients was 186 months, 13 months and 4 months in the 0–19, 20–49 and 50+ years of age, respectively.

Extragonadal choriocarcinoma in males is a rare malignancy with a poor prognosis. A young age at diagnosis and primary tumor site in the brain were the independent prognostic factors.

• beam radiation
• choriocarcinoma
• incidence
• prognosis
• surgery

•

We detailed a collision tumor of gastric choriocarcinoma and small cell carcinoma.

Both gastric choriocarcinoma and small cell carcinoma are extremely rare, both accounting for approximately 0.1% of all gastric cancers. Therefore, simultaneous occurrence of gastric choriocarcinoma and small cell carcinoma is even rarer.

An 84-year-old Japanese man was referred to our hospital with the chief complaint of dysphagia. Laboratory data showed iron deficiency anemia. Contrast-enhanced computed tomography of the abdomen revealed thickened wall of the stomach at the fundus and several enlarged abdominal lymph nodes. Upper gastrointestinal endoscopy showed a friable gastric tumor with necrosis in the gastric cardia extending to the abdominal esophagus. Small cell carcinoma was diagnosed based on pathological examination of biopsy specimens. The anemia, which was probably because of tumor bleeding, progressed despite repeated transfusion; therefore, a semi-urgent laparotomy was performed to control hemorrhage. Finally, total gastrectomy and lymph node resection were performed. Based on pathological findings, a diagnosis of collision tumor of choriocarcinoma and small cell carcinoma of the stomach was confirmed.

When encountering large tumors with necrosis or hemorrhage in the stomach, the possibility of choriocarcinoma component should be considered. Moreover, when small cell carcinoma is morphologically suspected, even if slightly, additional immunohistochemical staining must be performed.

This report detailed an extremely rare case of collision tumor of choriocarcinoma and small cell carcinoma of the stomach.

• Case report
• Choriocarcinoma
• Collision tumour
• Endocrine carcinoma
• Human chorionic gonadotropin
• Small cell carcinoma

• Chemotherapy
• Choriocarcinoma
• Gastric Cancer

•

Primary gastric choriocarcinoma is a rare and aggressive tumour with poor prognosis.

Primary gastric choriocarcinoma accounts for 0.08% of all gastric cancers. It is a rapidly growing, widely metastatic and β-HCG-producing tumour of trophoblastic cells.

A 69-year-old white man presented to the hospital with symptomatic anaemia. An upper gastrointestinal endoscopy showed an ulcer of the cardia and lesser curvature, whose biopsy specimens proved to be malignant (carcinoma cells, non-specified). The patient underwent total gastrectomy with D2 lymphadenectomy. A histologic evaluation revealed a choriocarcinoma admixed with adenocarcinoma cells without lymph node metastases. The patient died from haemorrhagic shock, due to rupture of liver metastases and a massive haemoperitoneum, within 2 months of the initial presentation.

Primary gastric choriocarcinoma characteristics resemble those of gastric primary adenocarcinoma. The dedifferentiation theory is the most widely accepted theory to explain the pathogenesis of PGC. It is essential to rule out other possible primary lesions such as testicular tumour. The optimal treatment is not yet well established due to very few reported cases.

Primary gastric choriocarcinoma is a rare tumour with an aggressive behaviour and very poor prognosis.

To analyze the management and prognosis of primary choriocarcinoma (PCC) in male patients.

The clinical records of males with PCC who were treated at Peking Union Medical College Hospital between 1990 and 2012 were analyzed retrospectively. The literature regarding this clinical condition was also reviewed.

The median survival interval of the 13 patients treated at Peking Union Medical College Hospital was 54 months (range, 6–115 months), and the 1- and 3-year survival rates were 53.8% and 43.1%, respectively. All patients were treated with surgery; 12 were treated with combined chemotherapy. After including 100 cases found in the literature, for a total of 113 patients, the median survival interval was 10 months (range, 6.4–13.6 months). The testis was the most common primary site (36.2%). Most patients (70.9%) had metastatic lesions at diagnosis. Univariate and multivariate analyses revealed that longer median overall survival was significantly associated with patient age <34 years old (48 months vs 10 months, odds ratio [OR] =0.47, P=0.029), the presence of other histological components (54 months vs 11 months, OR =0.54, P=0.011), and combined chemotherapy and surgical treatments (14 months vs 2.5 months, OR =0.18, P=0.002).

PCC is an extremely rare disease among men, and its prognosis is much worse than that of gestational choriocarcinoma. The complete resection of the primary site and metastases followed by chemotherapy seems to provide patients with the best chance at survival. Furthermore, additional chemotherapy cycles might facilitate better progress.

• PCC
• men
• prognosis

• chemotherapy
• choriocarcinoma
• posterior mediastinum
• surgery

• Beta-human chorionic gonadotropin
• Etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine
• Oligometastatic
• Primary gastric choriocarcinoma
• Radiofrequency ablation

• Aged
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Biopsy
• Catheter Ablation
• Choriocarcinoma, Non-gestational/secondary
• Choriocarcinoma, Non-gestational/therapy
• Endoscopy, Digestive System
• Female
• Gastrectomy
• Humans
• Immunohistochemistry
• Liver Neoplasms/secondary
• Liver Neoplasms/therapy
• Lung Neoplasms/secondary
• Lung Neoplasms/therapy
• Lymph Node Excision
• Stomach Neoplasms/pathology
• Stomach Neoplasms/therapy
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome

• Adenocarcinoma/metabolism
• Adenocarcinoma/mortality
• Adenocarcinoma/secondary
• Biomarkers, Tumor/metabolism
• Breast Neoplasms/diagnosis
• Breast Neoplasms/secondary
• Carcinoma, Intraductal, Noninfiltrating/pathology
• Diagnosis, Differential
• Female
• Gastric Mucosa/metabolism
• Gastric Mucosa/pathology
• Humans
• Intestinal Mucosa/metabolism
• Intestinal Mucosa/pathology
• Male
• Mexico/epidemiology
• Middle Aged
• Neoplasm Invasiveness
• Neoplasm Staging
• Prognosis
• Stomach Neoplasms/metabolism
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Survival Rate

• Gastric choriocarcinoma
• Trastuzumab
• cErbB2

• Beta human chorionic gonadotrophin
• chorioadenocarcinoma
• gastric choriocarcinoma.

The case of adenocarcinoma with human chorionic gonadtropin (HCG), primary in the male gallbladder, is extremely rare. A Medline search has shown only a few similar cases reported.

We herein describe a case of primary gallbladder adenocarcinoma associated by ectopic HCG positive tumor cells in a 79-year-old male.

Pathological examination showed a mixture of moderately and poorly differentiated adenocarcinoma with ectopic HCG and placental alkaline phosphatase (PlAP) in tumor cells, though the increase of serum or urinary HCG secretion was not confirmed. The literatures were also reviewed.

A case of gallbladder cancer with ectopic HCG production is quite rare in the literature, though many similar cases in other site, especially in GI tract, are reported. Embryological consideration suggests the increased frequency of similar cases more than being thought now.

• Adrenal Gland Neoplasms/secondary
• Adult
• Brain Neoplasms/secondary
• Choriocarcinoma/pathology
• Chorionic Gonadotropin/blood
• Humans
• Ki-67 Antigen/analysis
• Liver Neoplasms/pathology
• Lung Neoplasms/secondary
• Male
• Middle Aged
• Peritoneal Neoplasms/secondary
• Placental Lactogen/analysis

We report a case of gastric choriocarcinoma admixed with an α-fetoprotein (AFP)-producing adenocarcinoma. A 70-year-old man was hospitalized for gastric cancer that was detected during screening by esophagogastroduodenoscopy (EGD). Initial laboratory data showed the increased serum level of AFP and EGD revealed a 5-cm ulcerofungating mass in the greater curvature of the gastric antrum. The patient underwent radical subtotal gastrectomy with D2 lymph node dissection and Billroth II gastrojejunostomy. Histopathological evaluation confirmed double primary gastric cancer: gastric choriocarcinoma admixed with an AFP-producing adenocarcinoma and separated adenocarcinoma. At 2 wk postoperatively, his human chorionic gonadotropin and AFP levels had reduced and six cycles of adjuvant chemotherapy were initiated. No recurrence or distant metastasis was observed at 4 years postoperatively.

• α-fetoproteins
• Adenocarcinoma
• Choriocarcinoma
• Stomach neoplasms

• Adenocarcinoma/pathology
• Adult
• Aged
• Alleles
• Choriocarcinoma/genetics
• Chromosome Deletion
• Female
• Genes, p53
• Humans
• Immunohistochemistry
• Loss of Heterozygosity
• Male
• Mutation
• PTEN Phosphohydrolase/genetics
• Stomach Neoplasms/pathology

• Choriocarcinoma
• Stomach

We described a patient with adenocarcinoma of the stomach combined with choriocarcinoma and neuroendocrine cell carcinoma. An 85-year-old man visited our hospital because of appetite loss. Gastric fiberscopy revealed a large tumor occupying the cardial region and anterior wall of the gastric body. The patient underwent total gastrectomy with lymphnode dissection and partial resection of the liver. Choriocarcinoma, small cell carcinoma and tubular adenocarcinoma existed in the gastric tumor. The choriocarcinomatous foci contained cells positive for beta-subunit of human chorionic gonadotropin (B-hCG) and human placental lactogen mainly in syncytiotrophoblastic cells. The small cell carcinomatous foci contained cells positive for synaptophysin, neuron-specific enolase (NSE), and chromogranin A. The prognosis for gastric adenocarcinoma with choriocarcinoma and neuroendocrine cell carcinoma is exceedingly poor. This patient died about 2 mo after the first complaint from hepatic failure. This is the first reported case of gastric cancer with these three pathological features.

• Gastric cancer
• Choriocarcinoma
• Neuroen-docrine cell carcinoma
• Tubular adenocarcinoma
• Combined carcinoma

• Adult
• Choriocarcinoma/secondary
• Humans
• Male
• Stomach Neoplasms/secondary
• Testicular Neoplasms/pathology