Choriocarcinoma Presenting as a Pleural Effusion.

Marie-Louise Posch,Sunoj Abraham,Leonard Hamera,Jeffrey Jordan

doi:10.7759/cureus.9667

Abstract

Choriocarcinoma is a germ cell tumor characterized by widespread metastases and poorly differentiated cells. Non-gestational choriocarcinoma, or primary choriocarcinoma is a trophoblastic disease which is associated with a poor patient prognosis and is markedly angioinvasive. Primary non-gestational mediastinal choriocarcinoma is a very rare disease and represents an aggressive malignancy, primarily seen in young males. Those with primary mediastinal choriocarcinoma have symptoms that are non-specific such as cough, dyspnea, hemoptysis, and chest pain.Here we present the case of a 47-year-old Caucasian female who presented with worsening dyspnea and cough. Laboratory testing revealed elevated alkaline phosphatase, human chorionic gonadotropin, and cancer antigen 125. Chest X-ray was significant for a large right pleural effusion and a computed tomography angiogram of the chest showed a soft tissue mass in the anterior medial right lung base/right middle lobe. Thoracentesis yielded results consistent with malignant cells favoring a germ cell tumor. Biopsy of the mediastinal mass revealed positivity for inhibin and both human chorionic gonadotropin and CD-10 which led to the diagnosis of primary choriocarcinoma.Primary mediastinal choriocarcinoma is uncommon and often has a non-specific clinical presentation. A high degree of suspicion is needed as this malignancy can be aggressive, necessitating urgent definitive tissue biopsy diagnosis to guide appropriate therapy.

Highlights

Choriocarcinoma is a nonseminomatous germ cell tumor with poorly differentiated cells
Non-gestational choriocarcinoma, or primary choriocarcinoma (PCC), is a considerably uncommon trophoblastic disease which is associated with a poor patient prognosis and is markedly angioinvasive
While exact numbers are unknown, some have postulated that the incidence of extragonadal germ cell tumors is between 1.8 to 3.4/1 million with germ cell tumors in general accounting for up to 16% of mediastinal tumors [2, 3]

Summary

Introduction

Choriocarcinoma is a nonseminomatous germ cell tumor with poorly differentiated cells. Non-gestational choriocarcinoma, or primary choriocarcinoma (PCC), is a considerably uncommon trophoblastic disease which is associated with a poor patient prognosis and is markedly angioinvasive It is by definition without a primary tumor in the ovaries or testes and does not include metastatic disease to the retroperitoneal lymph nodes. It is still unclear as to how PCC develops, but it has been postulated that it may be the result of a metastasis from a primary gonadal choriocarcinoma that spontaneously regressed It may take its origin from retained primordial germ cells that, during embryogenesis, abnormally migrate [9]. Pertinent negative findings included no fevers, chills, upper respiratory symptoms, hemoptysis, orthopnea, swelling, additional chest pain, or weight changes. Her past medical history was significant for menorrhagia and uterine ablation 15 years ago. The patient’s breathing improved after pleural fluid drainage and she was discharged to follow up with a positron emission tomography (PET) scan and Oncologist as an outpatient

Discussion

Conclusions

Disclosures

Findings

Lurain JR