A RARE CASE OF PRIMARY MEDIASTINAL CHORIOCARCINOMA IN A YOUNG MALE

Abstract

SESSION TITLE: Medical Student/Resident Disorders of the Mediastinum Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Choriocarcinoma is a trophoblastic tumor that can be gestational or secondary choriocarcinoma and non-gestational or primary choriocarcinoma (PCC). Mediastinal choriocarcinoma without a detectable primary is an extremely rare tumor with an annual incidence rate of 2.1 cases per 100,000 males. We present a case of primary mediastinal choriocarcinoma in a young male patient. CASE PRESENTATION: A 18-year-old male presented with cough, shortness of breath, high grade fever, night sweats for 2 weeks. Physical examination revealed bibasilar crackles and right upper quadrant tenderness. Labs showed elevated WBC, LFTs, ESR, CRP and LDH. Chest radiology showed bilateral lung masses with mediastinal and periaortic lymphadenopathy. CT chest abdomen and pelvis showed innumerable diffuse bilateral lung masses, large anterior mediastinal lymph nodes and small periaortic and paratracheal lymph nodes. MRI brain showed numerous supratentorial and infratentorial nodules. Infectious workup was negative. Ultrasound of testicle was negative for testicular mass. B-HCG were 699,181 mIU/ml but AFP was 0.7 ng/ml. CT guided biopsy of lung mass confirmed poorly differentiated stage 3C choriocarcinoma. Patient did not respond to different regime of chemotherapy and unfortunately passed away from multiorgan failure. DISCUSSION: PCC preferentially involves midline structures including central nervous system, pineal body, mediastinum, retroperitoneum, lung, and liver. Median age of occurrence is between 15 to 35 years. In PCC, arrest of gonadal cell migration happens somewhere along the urogenital ridge, where they remain dormant until an unknown stimulus causes them to develop into a tumor. Common presentations are dry cough, hemoptysis and dyspnea. It presents as a rapidly growing non-cavitating well-defined anterior mediastinal mass. Tumor cells release B-HCG, which is used as a tumor marker for diagnosis, staging and monitoring. Immunohistochemical staining is positive for both HCG and CAM 5.2. PCC is an aggressive angioinvasive tumor that metastasizes to the lung and brain. Early diagnosis is difficult due to its rare presentation and atypical symptoms. Diagnosis is made by high serum B-HCG and presence of mononuclear trophoblasts intermixed with syncytiotrophoblasts in biopsy. Unlike germ cell tumor, mediastinal choriocarcinoma has very poor prognosis. Bleomycin, etoposide and cisplatin regimen are being used as standard first line chemotherapy. CONCLUSIONS: Some studies showed an improved survival rate up to 2 years with surgery and chemotherapy. Considering poor prognosis more research needs to be done to explore newer chemotherapy/immunotherapy to improve survival rate. Reference #1: Zhang, S., Gao, H., Wang, X.-A., Liang, B., Li, D.-W., Shao, Y., & Jiang, S.-J. (2014, September). Primary choriocarcinoma in mediastinum with multiple lung metastases in a male patient: A case report and a review of the literature. Reference #2: Oncology, D. of. (n.d.). Male primary mediastinal choriocarcinoma with diffuse... : Medicine. Retrieved from https://journals.lww.com/md-journal/Pages/articleviewer.aspx?year=2019&issue=07120&article=00069&type=Fulltext DISCLOSURES: No relevant relationships by Miguel Conde, source=Web Response No relevant relationships by Hameeda khan, source=Web Response No relevant relationships by Pooja Raju, source=Web Response No relevant relationships by Ehsen Rao, source=Web Response No relevant relationships by Aditi Saha, source=Web Response