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Kővári B, Carneiro F, Lauwers GY. Epithelial tumours of the stomach. MORSON AND DAWSON'S GASTROINTESTINAL PATHOLOGY 2024:227-286. [DOI: 10.1002/9781119423195.ch13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Garcia Pleitez H, Saowapa S, Olavarria-Bernal D, Juarez M, Kanitthamniyom C, Verma U. Revealing the Unanticipated: An Uncommon Case of Colorectal Adenocarcinoma Transitioning to Choriocarcinoma - A Case Report and Literature Review. Eur J Case Rep Intern Med 2024; 11:004838. [PMID: 39372162 PMCID: PMC11451844 DOI: 10.12890/2024_004838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 08/26/2024] [Indexed: 10/08/2024] Open
Abstract
Choriocarcinomas are uncommon tumors, with non-gestational types occurring in both males and females. Primary choriocarcinoma of the colon is extremely rare. It presents significant diagnostic and therapeutic challenges due to its aggressive nature and poor prognosis, with no cure available, and a mean survival of 8 months. This case report describes a 48-year-old woman who presented with abdominal pain and an ovarian mass, initially suspected to be ovarian cancer. Further workup showed a primary tumor in the colon, with extension to the ovary and liver metastasis. The pathology findings confirmed the presence of colorectal adenocarcinoma with choriocarcinomatous differentiation, as indicated by immunohistochemistry. The patient initially responded to the cisplatin/etoposide regimen; however, she relapsed shortly after. The patient received additional treatments with pembrolizumab, paclitaxel, and olaparib, which resulted in partial remission. Despite challenges during treatment, such as suspected uveitis related to immune-checkpoint inhibitors and potential interference of antibodies with beta-human chorionic gonadotropin (β-hCG) testing, the patient maintained a good performance status for over 1.5 years after being diagnosed. The case emphasizes the difficulties in treating choriocarcinomas, primarily because of their aggressiveness and the absence of standardized therapy. Our goal with this case is to draw multidisciplinary attention to this rare condition. Further studies are necessary to comprehend its clinical characteristics, prognosis factors, molecular markers, and treatment approaches. Such studies may be crucial in establishing targeted and personalized therapy. LEARNING POINTS Primary choriocarcinoma of the colon is rare and often misdiagnosed due to its atypical presentation, complicating timely and accurate diagnosis.The aggressive nature of this tumor and lack of standardized therapy necessitates a multidisciplinary approach and personalized treatment plans, especially following relapse.Molecular profiling guided the use of immunotherapy, which showed potential but also presented challenges, highlighting the need for further research in treating this rare malignancy.
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Affiliation(s)
- Hector Garcia Pleitez
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Sakditad Saowapa
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Diego Olavarria-Bernal
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Michel Juarez
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | | | - Udit Verma
- Department of Hematology/Oncology, Texas Tech University Health Science Center, Lubbock, USA
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Zhao Y, Diao W, Li S, Yang M, Cheng Z. Case Report: a rare primary gastric choriocarcinoma revealed on 18F-FDG PET/CT. Front Oncol 2023; 13:1227236. [PMID: 38023162 PMCID: PMC10666916 DOI: 10.3389/fonc.2023.1227236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023] Open
Abstract
Choriocarcinoma is an exceptionally aggressive trophoblastic cell tumor that that typically originates in gonadal tissues, with rare occurrences outside the gonads, including the mediastinum, retroperitoneum, and intracranial sites. However, it rarely occurs in the stomach. Herein, we presented a case of primary gastric choriocarcinoma in a 27-year-old female patient who found multiple liver masses detected during physical examination, accompanied by remarkably elevated human chorionic gonadotropin levels. The 18F-FDG PET/CT scan suggested ring-shaped intense uptake masses located in the gastric sinus and liver, and no significance in the pelvic region. Final histopathology indicated primary choriocarcinoma of the stomach. This case illustrates that 18F-FDG PET/CT is an essential imaging technique for the clinical diagnosis and stage of primary choriocarcinoma.
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Affiliation(s)
- Yi Zhao
- Department of Nuclear Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Wei Diao
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Suping Li
- Department of Nuclear Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Mengxi Yang
- Department of Radiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Zhuzhong Cheng
- Department of Nuclear Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, China
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Xusheng Z, Yuke Y, Yun M, Huijun G, Jiangshan P, Xueqin D, Xiaojun Y. Primary gastric choriocarcinoma: A case report. Front Surg 2022; 9:1009119. [PMID: 36406377 PMCID: PMC9666900 DOI: 10.3389/fsurg.2022.1009119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/10/2022] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Choriocarcinoma is a malignant tumour of trophoblastic origin. Most are gestational choriocarcinomas, which usually occur in women with an epithelial origin of the placental chorionic villi and are associated with pregnancy. It mainly originates in the gonads such as the ovaries and testes. However, it rarely occurs in the stomach and is known as primary choriocarcinoma (PGC). CASE PRESENTATION A 69-year-old man complained of abdominal distention for 3 years, which worsened 1 week later. Gastroscopy showed chronic atrophic gastritis C1 (C1: indicates atrophic gastritis involving the sinus region); the pathology report of the gastroscopic specimen showed high-grade epithelial tumours in the mucosal glands. We diagnosed an occupying lesion in the stomach and performed a laparoscopically assisted distal gastrectomy and Billroth type 1 anastomosis. Postoperative pathology showed "gastric choriocarcinoma with cancerous tissue invading the entire gastric wall". The patient was discharged on the 11th postoperative day as there were no postoperative complications. The patient was followed up until June 2022 with a good recovery and no recurrence. CONCLUSION We encountered a case of Primary Gastric Choriocarcinoma, where the cancerous tissue invades the full thickness of the gastric wall.
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Affiliation(s)
- Zhang Xusheng
- The 1st Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, China
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Yan Yuke
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
- School of People's Clinical Medicine, Lanzhou University, Lanzhou, China
- Gansu Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology, Gansu Provincial Hospital, Lanzhou, China
- Gansu Research Center of Prevention and Control Project for Digestive Oncology, Gansu Provincial Hospital, Lanzhou, China
| | - Meng Yun
- The 1st Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, China
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Guo Huijun
- The 1st Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, China
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Peng Jiangshan
- The 1st Clinical Medicine College, Gansu University of Chinese Medicine, Lanzhou, China
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Du Xueqin
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
- College of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Yang Xiaojun
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
- School of People's Clinical Medicine, Lanzhou University, Lanzhou, China
- Gansu Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology, Gansu Provincial Hospital, Lanzhou, China
- Gansu Research Center of Prevention and Control Project for Digestive Oncology, Gansu Provincial Hospital, Lanzhou, China
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A locally advanced primary gastric adenocarcinoma with a choriocarcinomatous component successfully treated by FLOT chemotherapy and surgery: A Case Report and Literature Review. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2022. [DOI: 10.1016/j.cpccr.2022.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Chen L, Yi X, Zou HL, Chen XA, Gao S, Zhang PH. Coexistence of gastric choriocarcinoma and adenocarcinoma with reproductive hormone secretion in a man: a case report. J Int Med Res 2020; 48:300060520904876. [PMID: 32216498 PMCID: PMC7133413 DOI: 10.1177/0300060520904876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The present study reports a rare case of a 65-year-old male patient with an exophytic ulcerative lesion in the gastric antrum. After performing a radical subtotal gastrectomy with D2 lymph node dissection and Billroth I gastrojejunostomy, histological analysis revealed a poorly differentiated adenocarcinoma combined with a biphasic pattern consisting of cytotrophoblasts and syncytiotrophoblasts. Immunohistochemical analysis showed a positive reaction with an anti-β-human chorionic gonadotropin antibody, and an abnormal increase in reproductive hormones. Furthermore, the patient succumbed to upper gastrointestinal hemorrhage in less than 3 months after the initial diagnosis, although the rupture of his liver metastasis was successfully treated by transhepatic artery embolization during the second admission.
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Affiliation(s)
- Lei Chen
- Department of General Surgery, Qilu Hospital of Shandong University (Qingdao), Qingdao, China
| | - Xin Yi
- Department of General Surgery, Qilu Hospital of Shandong University (Qingdao), Qingdao, China
| | - Hong-Li Zou
- Department of Gynaecology, Qilu Hospital of Shandong University (Qingdao), Qingdao, China
| | - Xu-An Chen
- Department of General Surgery, Qilu Hospital of Shandong University (Qingdao), Qingdao, China
| | - Shang Gao
- Department of General Surgery, Qilu Hospital of Shandong University (Qingdao), Qingdao, China
| | - Pei-Hai Zhang
- Department of Gynaecology, Qilu Hospital of Shandong University (Qingdao), Qingdao, China
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Picazo Ferrera K, Herrera Servin MÁ, Hernández Guerrero AI. Primary gastric choriocarcinoma. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:241. [PMID: 32022576 DOI: 10.17235/reed.2020.6478/2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Choriocarcinomas are epitelial tumors with a rapidly growing rate and widely metastatic tumor of trophoblastic cells. Incidence have been reported 1 in 24,096 pregnant patients. Most cases arise in the uterus following gestational events. It can also be gonadal or extragonadal. primary gastric choriocarcinoma is rare, represents 0.08% of all gastric cancers. Clinical presentation is very similar to adenocarcinomas but they can present seric β-GCH elevation. The main objective is present three cases of primary gastric choriocarcinoma with an initial miss diagnosis of adenocarcimoa.
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Gurzu S, Copotoiu C, Tugui A, Kwizera C, Szodorai R, Jung I. Primary gastric choriocarcinoma - a rare and aggressive tumor with multilineage differentiation: A case report. World J Clin Cases 2019; 7:1837-1843. [PMID: 31417929 PMCID: PMC6692267 DOI: 10.12998/wjcc.v7.i14.1837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/28/2019] [Accepted: 06/10/2019] [Indexed: 02/05/2023] Open
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.
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Affiliation(s)
- Simona Gurzu
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures 530149, Romania
- Research Center (CCAMF), University of Medicine, Pharmacy, Sciences and Technology, Targu Mures 540139, Romania
| | - Constantin Copotoiu
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures 530149, Romania
| | - Alexandra Tugui
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures 530149, Romania
| | - Cedric Kwizera
- Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures 530149, Romania
| | - Rita Szodorai
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures 530149, Romania
| | - Ioan Jung
- Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures 530149, Romania
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Hirotsu A, Hiramatsu Y, Kawata S, Matsumoto T, Ozaki Y, Kikuchi H, Baba M, Kamiya K, Konno H, Takeuchi H. Rapid recurrence of primary gastric choriocarcinoma after complete resection. Int J Surg Case Rep 2019; 57:138-141. [PMID: 30959361 PMCID: PMC6453829 DOI: 10.1016/j.ijscr.2019.03.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/18/2019] [Accepted: 03/24/2019] [Indexed: 11/16/2022] Open
Abstract
A 78-year-old man was diagnosed with stage cIB primary gastric choriocarcinoma. Total gastrectomy with spleen-preserving D2 lymphadenectomy was performed. Early recurrence was diagnosed 3 months postoperatively. The patient underwent a standard nongestational choriocarcinoma chemotherapy. Introduction 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. Presentation of case 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. Conclusion We report a case of stage pIB PGC with poor prognosis, recurring at only 3 months postoperatively despite curative surgery and chemotherapy.
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Affiliation(s)
- Amane Hirotsu
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshihiro Hiramatsu
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Sanshiro Kawata
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Matsumoto
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yusuke Ozaki
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Emergency and Disaster, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Megumi Baba
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kinji Kamiya
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroyuki Konno
- Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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