Choriocarcinoma Research Articles

Overexpression of hypoxia-inducible factor 1α induces migration and invasion through Notch signaling.

Choriocarcinoma (CC) is the highest malignant gestational trophoblastic tumor which causes high mortality without timely treatment. HIF-1α is a very important molecule promoting neoplasm aggressiveness, metastasis through the induction of the epithelial to mesenchymal transition (EMT). Several researches have shown that Notch signaling is necessary for coupling hypoxia to the EMT. However, the pathway in choriocarcinoma remains undetermined. In this study, overexpression of HIF-1α inhibited epithelial index E-cadherin, cytokeratin 18 (CK18) and cytokeratin 19 (CK19) in two choriocarcinoma cell lines (JAR and JEG-3, respectively). The reciprocal changes associated with the EMT phenotypic transformation. The migration and invasive capability was significantly enhanced. HIF-1α overexpression was positively correlated with Notch1 and Hes1 (P<0.01; respectively). Using DAPT (Notch1 inhibitor) to knock down Notch1 expression, morphological and molecular typical changes of the EMT were detected in vitro. Knockdown of Notch1 prominently reduced MMP2 and MMP9 activities, and increased E-cadherin, CK18 and CK19 expression in JAR and JEG-3 cells (P<0.01). In vivo, serum-free suspension containing 5x106 JAR cells (lv-HIF-1α and lv-NC, respecticely) were implanted subcutaneously or injected intravenously into female NOD SCID mice, which were injected with DAPT or DMSO six times at 3-day intervals. Mice with subcutaneous nodules were injected i.v. fluorine-18 fluorodeoxyglucose (18F-FDG) and then scanned in small animal PET/CT (SA-PET/CT), and mice with lung metastasis were monitored by using the in vivo imaging system (IVIS). The in vivo data showed that inhibition of Notch signaling by DAPT treatment effectively suppressed metastatic tumor growth, metabolic activity and invasion. In summary, overexpression of HIF-1α promotes choriocarcinoma cell aggressiveness and metastasis through the regulation of the EMT dependenting on Notch signaling pathway.

Study on in vitro model of hepatitis B virus-infected transwell chambers mediated by peripheral blood mononuclear cells

Objective To observe the transport of hepatitis B virus (HBV)-infected peripheral blood mononuclear cells (PBMC) through placental barrier set up by choriocarcinoma trophoblast cells (Bewo cells), and to explore the biological role of PBMC as a carrier for HBV transport. Methods Bewo cells and PBMC were cultured and their proliferation and activity were detected by cell counting kit (CCK)-8. One hundred μL serum containing 5×106 copy/mL HBV DNA was used to infect PBMC, and cells infected with HBV were labeled by fluorescent dye carboxyfluorescein diacetate succinimidyl ester (CFSE). A co-culture model of Bewo cells and HBV-infected PBMC was set up by transwell chamber. The migration of HBV-infected PBMC was detected by flow cytometry. Realtime fluorescence quantitative polymerase chain reaction method was used to detect HBV DNA contents of PBMC under transwell chamber. Results PBMC and Bewo cells proliferated at around 24 h and entered into growth stagnation at around 120 h. The contents of PBMC labeled by green fluorescent at 0, 12, 24 and 48 h during co-culture under chamber were (0.445±0.021)%, (21.180±4.653)%, (34.830±7.156)% and (64.185±3.161)%, respectively. The amount of PBMC marked green fluorescence increased over prolonged incubation time (F=68.983, P=0.001). PBMC HBV DNA contents at 24 and 48 h of co-culture under chamber were (1.925±0.431)×103 copy/mL and (2.565±0.361)×103 copy/mL, respectively, indicating that PBMC under chamber were infected with HBV. Conclusions PBMC may be a target for HBV infection in extrahepatic tissues. Placental trophoblastic barrier built by transwell chambers may provide new ideas to investigate HBV transmission across the placenta in vitro. Key words: Hepatitis B virus; Peripheral blood mononuclear cells; Bewo cells; Transwell chamber

Primary pulmonary cancer colliding with metastatic choriocarcinoma.

Collision tumors are rare in nature. Although lung is one of the main organs where metastatic tumors may occur, collision neoplasms consisting of a primary lung cancer and metastatic choriocarcinoma have never been reported so far. Here we describe a case of primary squamous-cell lung carcinoma (SCC) colliding with metastatic choriocarcinoma in a 55-year-old woman.

Delayed Presentation of Patients with Gynaecological Malignancies in Kano, North-Western Nigeria

The diagnosis and management of gynaecological cancers are still challenging in low- and middle-income countries. In patients with gynaecological malignancies delay at any point increases morbidity and mortality. This study evaluated the factors that may delay presentation, diagnosis and treatment of patients with malignant gynaecological cancers, and described the duration of each delay. It was a prospective cross-sectional study. A total number of 96 patients diagnosed to have gynaecological malignancy were enrolled in the study between the April 2014 and April 2015. The median age was 47.5 years (range of 18 - 84 years). The diagnoses on admission were cervical malignancy 34 (35.42%), ovarian malignancy 32 (33.33%), chorio carcinoma 15 (15.63%), cancers of uterine body (endometrial and leiomyosarcoma) 10 (10.42%) and vulval malignancies 5 (5.2%). Majority of the patients 65 (67.7%) presented late at either stage III or IV. At presentation, 36 patients (37.5%) had severe anaemia; 10 patients (10.41%) had obstructive uropathy; 3 (3.13%) developed fistula; 19 (19.79%) died on admission from complication of their disease. Most patients 61 (63.54%) had delayed presentation of more than 90 days (“patients delay”). Time in decision ranged between 3 days to maximum of 2920 days and median of 150 days. 58 (60.42%) gave a reason for such delay as lack of knowledge of their presenting symptoms, as a warning sign of possible malignancy; 80 (83.33%) had delay in diagnosis (“doctor delay”); 40 (41.67%) reported that the medical practitioner did not make referral to the center with available gynaecological services; “hospital delay” was observed in 66 (68.75%) of patients. The reason for delayed treatment in 35 (36.46%) of patients was severe patients condition that warrant stabilization (blood transfusion and dialysis) and 29 (30.21%) could not afford the treatment. Late presentation is a great problem in the management of oncological patients in this environment. High cost of care is the major challenge for the patients and gynaecologist in north-western part of Nigeria.

Acute Clinical Presentation of Metastatic Testicular Choriocarcinoma: A Case Report and Brief Review of Literature

We present an unusual case of a 23-year-old Hispanic male with no past medical history, who presented with 2 days history of diffuse abdominal pain. CT scan showed widely bleeding metastatic lesions in the retroperitoneum, lungs and liver causing large hemothorax and hemoperitoneum. He developed acute symptomatic anemia and needed interventional radiology-guided embolization of hepatic artery in addition with an urgent chest tube to relieve the symptoms along with transfusion. Subsequent exam found a true choriocarcinoma of the right testis. Following chemotherapy, the patient’s lesions shrunk and his anemia improved. A review of literature shows that testicular choriocarcinoma is a rare aggressive malignancy which metastasizes hematogenously and bleeds extensively due to their high vascularity. They can present with acute symptoms and signs that often lead patients to seek emergency care. Acute bleeding manifestation could be also the first presentation often leading to the final diagnosis of choriocarcinoma like in this case. J Med Cases. 2014;5(12):639-642 doi: http://dx.doi.org/10.14740/jmc1943w

Expression of C1QBP gene and its correlation with drug resistance in human resistance choriocarcinoma cell line

To examine the complement component 1 Q subcomponent-binding protein (C1QBP) gene expression in human resistance choriocarcinoma cell lines and its parental cell line JeG-3, and to investigate whether silence C1QBP by small interference RNA could reverse the resistance of human resistance choriocarcinoma cell lines to its relevant chemotherapy drugs. Expression of C1QBP mRNA and protein in cells were detected by real- time fluorogenic quantitative PCR and western blot, respectively. The difference of C1QBP expression was compared between human resistance choriocarcinoma cell lines and its parental cell line JeG-3. Sub-cellular location was proved by confocal immunofluorescence microscopy. A lentiviral vector containing short hairpin RNA (shRNA) targeting C1QBP was constructed and cotransfected with the packaging plasmid mixture into 293T cells by lipofectamine 2000. The human resistance choriocarcinoma cell lines were infected with the packaged lentivirus. Real- time fluorogenic quantitative PCR and western blot were used to validate whether the C1QBP gene expression was silenced. The cell counting kit 8 (CCK8) was used to determine the drug sensitivity. (1) The C1QBP mRNA expression levels among four human resistance choriocarcinoma cell lines [JeG-3/floxuridiuum (FUDR), JeG- 3/methotrexate (MTX), JeG-3/etoposide (VP), JeG-3/dactinomycin (KSM)] were 2.520 ±0.680, 1.770 ± 0.230, 1.940 ± 0.090 and 1.740 ± 0.350 folds compared to that in JeG- 3 cells. The C1QBP protein was higher expression level in human resistance choriocarcinoma cell lines than that in JeG-3. The immunofluorescence methods and confocal analysis showed that C1QBP localized predominantly in the mitochondrial matrix. (2) The C1QBP mRNA expression in JeG-3/FUDR cells after infected with lentiviral vector were decreased by 93.1% (P < 0.01). The protein expression of C1QBP in JeG-3/FUDR cells after infected with lentiviral vector were almost completely suppressed. The resistance indexes of four human resistance choriocarcinoma cell lines (JeG-3/FUDR, JeG-3/MTX, JeG-3/VP, JeG-3/KSM) were respectively 86.3% , 93.9% , 92.8% and 89.9%, which were decreased remarkably by knockdown the C1QBP expression (P < 0.05). C1QBP is overexpressed in human resistance choriocarcinoma cell lines compared with parental cell line JeG-3. Inhibition of C1QBP by lentivirus- mediated small interference RNA could effectively reverses the resistance of human resistance choriocarcinoma cell lines to its relevant chemotherapy drugs.

Rate of second primary tumors following diagnosed choriocarcinoma: A SEER analysis (1973–2010)

ObjectiveApproximately 1 in 6 of new cancers has been reported to represent a second primary tumor (SPT). Choriocarcinomas (CCs) are of interest in regard to the rate of SPTs because of the potential exposure to carcinogenic therapy and reports of the benefits of its high human gonadotropin (hCG) levels on cancer incidence. MethodsWe used the Surveillance, Epidemiology, and End Results (SEER) database to identify patients with gestational CC who subsequently developed a SPT. This is a retrospective study, following a cohort of patients during the period 1973–2010. ResultsWe found 818 patients with primary gestational CC. Nineteen patients had a SPT after the CC. Occurrence of several types of cancer resulted significantly higher when compared to the incidence rate in the general population. In particular the highest incidence rate ratios (IRRs) were registered for acute myeloid leukemia (AML) (6.3) and thyroid cancer (2.6). The expected rate of lung, breast, colorectal and uterine corpus cancers instead resulted lower than the rate in the general population. Regarding the IRR in the population under 50years of age, the higher IRRs were related to AML (20) and non-Hodgkin lymphoma (NHL) (5). ConclusionThe association of thyroid cancer and CC has not been described previously. Increases in hematological cancer following CC lend further support to the established data. The decrease in breast and colon cancers in all age groups supports past data and decreases in uterine and lung cancers are new observations meriting further study.

Classification and Morphology of Gestational Trophoblastic Disease

Gestational trophoblastic disease (GTD) is a clinically and morphologically very heterogeneous group of interrelated lesions, characterised by abnormal growth of the different types of trophoblastic cells, sometimes associated with villous dysmaturity. The management and follow up of the patients and risk calculation for persistent GTD is mainly based on histopathologic diagnosis. The morphologic and differential diagnostic criteria of the villous forms of GTD (complete, partial and invasive hydatidiform moles) are summarised in the paper as well as ancillary techniques for correct diagnoses. Exaggerated placental sites (EPS) and placental site nodules (PSN) represent benign lesions, derived from the intermediate trophoblast and their characteristics are given. The concept of atypical PSN as a recently defined lesion is discussed. Gestational choriocarcinoma (CC), placental site trophoblastic tumor (PSTT) and the epitheloid trophoblastic tumor (ETT) represent tumorous forms of GTD, also termed as gestational trophoblastic tumors (GTT). Their morphologic criteria and clues for differential diagnosis are given, including the discussion about the transition from one lesion into another.

Clinicopathologic Analysis of Choriocarcinoma as a Pure or Predominant Component of Germ Cell Tumor of the Testis

Although well recognized in the literature, the contemporary clinicopathologic data regarding choriocarcinoma (CC) as a pure or the predominant component of a testicular germ cell tumor (GCT) are limited. Herein, we present a series of pure CC and predominant CC in mixed GCT of the testis obtained from a single oncology institution. A comprehensive histologic review of 1010 orchiectomies from 1999 to 2011 yielded 6 (0.6%) pure CC and 9 (0.9%) mixed GCT cases with a predominant CC component. Patients' ages ranged from 20 to 39 years (median 29 y). All patients had markedly elevated serum β-hCG levels (median 199,000 IU/mL) at presentation. All tumors were unilateral and involved the right (9/15) and left (6/15) testis. The mean tumor size was 6.5 cm (range, 1.5 to 8 cm). Histology was similar for pure CCs and the CC component of mixed GCTs. CC commonly showed expansile hemorrhagic nodular cysts surrounded by variable layers of neoplastic trophoblastic cells (mononucleated trophoblasts and syncytiotrophoblasts). The syncytiotrophoblasts usually covered columns of mononucleated trophoblasts and occasionally formed plexiform aggregates and pseudovillous protrusions. Immunohistochemical stains suggested a mixture of cytotrophoblasts (p63+, HPL_) and intermediate trophoblasts (p63-, HPL weak +/-) in the columns of mononucleated cells. In the 9 mixed GCTs, CC comprised 50% to 95% (7/9 were ≥80% CC) of the tumor; 7 were combined with 1, and 2 were combined with 2 other GCT components. The non-CC components included teratoma (5/9), seminoma (2/9), yolk sac tumor (2/9), and embryonal carcinoma (2/9). Lymphovascular invasion, spermatic cord invasion, and tunica vaginalis invasion were present in 15/15, 5/15, and 1/12 cases, respectively. In mixed GCTs, these locally aggressive features were attributed to the CC component, except in 1 tumor in which it was also exhibited by the embryonal carcinoma component. Lymphovascular invasion was multifocal to widespread in 73% of tumors. The stages of the 15 tumors were: pT2 (10), pT3 (5); NX (1), N1 (4), N2 (5), N3 (5); and M1a (2) and M1b (13). Distant organ metastasis mostly involved the lungs (11) and liver (10). Follow-up information was available in 14 patients, all of whom received cisplatin-based chemotherapy. All 6 pure CC patients were dead of disease (range, 6 to 14 mo, median 9.5 mo). Follow-up of 8 patients with predominant CC (range, 10 to 72 mo, median 27 mo) showed that 5 died of the disease, and 1 was alive with disease and 2 were alive with no evidence of disease at 60 and 72 months of follow-up, respectively; these latter 2 patients were the only ones with M1a disease on presentation. This series confirms the proclivity for high-stage presentation including presence of distant metastasis, hematogenous spread, and poor outcome of testicular CC. Mixed GCT with a predominant CC component has similar tendency for high-stage presentation, marked elevation of serum β-hCG levels, and aggressive behavior compared with pure CC. This study also showed that distant metastasis by CC when only involving the lungs (M1a) may not be uniformly fatal with chemotherapy. The mononucleated trophoblastic columns in testicular CC appear to be a mixture of cytotrophoblasts and intermediate trophoblasts, similar to that described in gestational CC.

Metastastic Choriocarcinoma in a Term Pregnancy

The focus of this article is choriocarcinoma (CC), a rare and aggressive obstetric/gynecologic cancer that occurs once in every 20,000 to 40,000 pregnancies. CC is a form of gestational trophoblastic disease, which is the result of abnormal trophoblastic activity encompassing a spectrum of nonmalignant and malignant disease. Forms of gestational trophoblastic disease include complete or partial mole, invasive mole, CC, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Typically asymptomatic, the first symptom of CC in 80% of cases is shortness of breath, indicative of metastasis to the lungs. CC affects women of all ages and can occur during pregnancy, after birth, or even years remote from the antecedent pregnancy. It is highly responsive to chemotherapy, with an overall remission rate greater than 90%. This case study presents the story of a pregnant adolescent thought to have an uneventful pregnancy until metastatic CC at term was diagnosed. Available treatments, outcomes and surveillance for the disease, psychosocial aspects, and implications for nursing care are discussed.

Spontaneous Uterine Rupture in Choriocarcinoma During Chemotherapy: A Case Report and Literature Review

Amac: Koryakarsinoma bagli gelisen spontan uterus rupturu vakasini sundukVaka: 28 yasinda miad gebeligi takiben gelisen koryakarsinom tanili hastaya multiajan kemoterapi (Ethoposite 100mgr/m2 + cisplatin20mgr/m2) baslandi. Hastanin tedavisi sirasinda spontan uterus rupturu gelisti ve total abdominal histerektomi uygulandi.Sonuc: Gestasyonel trofoblastik hastaliklar icinde en ciddi seyreden formlardan biri olan koryokasinom medikal tedaviye ragmen spontan uterus perforasyonu ile prezente olabilir.

Targeted serum miRNA (TSmiR) test for diagnosis and follow-up of (testicular) germ cell cancer patients: A proof of principle

Germ cell cancers (GCC) are the most frequent malignancy in young Caucasian males. GCC can consist of seminomas (SE) and non-seminomas (malignant NS: embryonal carcinoma (EC), yolk sac tumor (YS), choriocarcinoma (CH) and teratoma (TE)). Current serum-markers used for diagnosis and follow-up (AFP, hCG) are predominantly related to YS and CH and marker positivity can vary during disease. Therefore, stable markers consistently identifying more GCC components, specifically the stem cell components SE and EC, are of interest. Expression of the embryonic stem cell miR-371-3 and miR-302/367 clusters in SE/EC/YS suggest possible application of these micro-RNAs as GCC tumor-markers. The TSmiR protocol constitutes a complete, quality-controlled pipeline for the detection of miRs in serum, based on magnetic bead-based purification and qPCR quantification. As a proof of principle, TSmiR was applied to five independent serum sample series including 80 GCCs, 47 controls, 11 matched pre/post orchidectomy samples and 12 no-GCC testicular masses. GCC serum samples showed a consistent, significant (p < 0.0064) increase of miR-371/372/373/367 levels. Analogous, serum levels returned to baseline after orchidectomy (stage-I disease). Moreover, there was a trend toward higher miR levels in patients with metastasis. These results imply suitability for diagnosis and follow-up. TSmiR showed an overall sensitivity of 98%, clearly outperforming the traditional serum markers AFP/hCG (36%/57%, sensitivityAFP = 3%/45%; sensitivityhCG = 62%/66%, SE/NS). TSmiR misclassified one tumor as a control. Serum AFP/hCG and TSmiR combined identified all T samples correctly. In conclusion, TSmiR constitutes a highly sensitive and reproducible serum test for GCC patients, suitable to be prospectively tested for diagnostic and follow-up purposes.

IMP1 promotes choriocarcinoma cell migration and invasion through the novel effectors RSK2 and PPME1

ObjectiveOncofetal protein insulin-like growth factor II mRNA-binding protein 1 (IMP1) regulates cellular proliferation and migration. Expression of IMP1 is limited to a few adult human tissues. However, it commonly expresses in a variety of cancers. Our objective was to study the regulatory mechanism of IMP1 on the cellular functions of choriocarcinoma (CC) JAR cells. MethodsIMP1 protein levels were measured in CC tissues via immunohistochemistry. Specific siRNAs were used to down-regulate gene expressions. The abilities of migration and invasion were estimated by wound-healing and Matrigel chamber assays. The profile of IMP1-binding genes was investigated with an Agilent microarray. RT-qPCR, RNA immunoprecipitation, and IMP1 rescue experiments were performed to confirm the association between IMP1 and its binding genes. Gene expression was further analyzed by using RT-PCR and Western blotting. ResultsStrong IMP1 expressions were frequently detected in CC tissues. Knockdown of IMP1 expression in JAR cells inhibited cell migration and invasion, but did not affect cellular proliferation and morphology. Microarray and RNA-immunoprecipitation results revealed several candidate genes regulated by IMP1. Among them, ribosomal protein S6 kinase (RSK2) and protein phosphatase methylesterase 1 (PPME1) were confirmed to be down-regulated in IMP1-depleted JAR cells. Re-expression of IMP1 into the cells restored the expressions of RSK2 and PPME1. Furthermore, the depletion of RSK2 or PPME1 decreased the migration and invasion of JAR cells. ConclusionOur results suggest that IMP1 plays an essential role in the regulation of migration and invasion of human CC cells, possibly through the novel effectors RSK2 and PPME1.

Role of endoplasmic reticulum protein folding molecular chaperones in floxuridine-resistance choriocarcinoma JeG-3/FUDRA cell line

To investigate changes of protein expression profiles between human choriocarcinoma JeG-3 cell line and its floxuridine (FUDR)-resistant sub-line. The differentially expressed proteins were identified by using two dimension difference gel electrophoresis (2-DE) and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) approaches. Gene ontology (GO) analysis and Pathway analysis were used to screen the candidate proteins. The levels of the proteins in chemo-resistant sub-lines were validated by western blot. Ribonucleic acid interference (RNAi) was used to knockdown the expression of calreticulin (CALR) and (or) protein disulfide-isomerase A3 (PDIA3) respectively. Forty-six proteins spots were found to be significantly different in spot intensity by statistical analysis between chemo-resistance sub-line and parent cell line, of which 31 proteins were identified by MALDI-TOF-MS. Comparing to the parent cell lines, three endoplasmic reticulum (ER) protein folding molecular chaperones: CALR, PDIA3 and 78 000 glucose-regulated protein (GRP78) screened out were increased significantly in floxuridine-resistant sub-line and were verified by western blot. The resistance index decreased by knockdown the CALR and/or PDIA3 expression in FUDR-resistant sub-line 76.3% (36.7 ± 2.0 vs. 8.7 ± 3.1, P < 0.05) and 51.4% (36.7 ± 2.0 vs. 17.8 ± 1.2, P < 0.05) respectively. These ER protein folding molecular chaperones, CALR, PDIA3 and GRP78, may involved in the mechanism of FUDR-resistance choriocarcinoma.

A Fibroid or Cancer? A Rare Case of Mixed Choriocarcinoma and Epithelioid Trophoblastic Tumour

Background. Gestational trophoblastic disease (GTD) is a rare complication of pregnancy which is characterised by abnormal growth of the trophoblasts at the placental site. It is categorised into benign and malignant forms, which include hydatidiform moles (HMs) and gestational trophoblastic neoplasia (GTN), respectively. A mixed choriocarcinoma (CC) and epithelioid trophoblastic tumour (ETT) is an extremely rare subgroup of GTN, which is a highly curable but aggressive form of malignancy. Case. We report a case of mixed CC and ETT in a 41-year-old patient who presented with a 2-year history of menorrhagia and fibroid uterus in the absence of previous history of molar pregnancy. She had a 12-year interval between the antecedent pregnancy and presentation. She was treated with intensive regimen of adjuvant chemotherapy, etoposide, methotrexate, and actinomycin-D with etoposide and cisplatin (EMA-EP). She has remained disease free for more than 5 years. Conclusion. This case highlights the importance of considering GTN as one of the differential diagnoses value of β-HCG in patients presented with menorrhagia and growing fibroids.

Atomic force microscopic observation and three-dimensional reconstruction of hepatitis immunoglobulins blocking hepatitis B virus infection of choriocarcinoma JAR cells

全国乙型肝炎流行病学调查表明,我国1～59岁一般人群HBsAg的携带率为7.18％,5岁以下儿童的HBsAg携带率为0.96％[1-2].在围产期和婴幼儿期感染HBV患者中,分别约有90％和25％ ～ 30％将发展成慢性乙型肝炎,其成年后发生肝硬化甚至肝癌的概率明显增加,因此阻断HBV宫内传播已成为围产医学和传染病学急待解决的问题[3-4]. 关键词：肝炎病毒,乙型;免疫球蛋白类;绒毛膜癌;细胞;显微镜检查,原子力

Comparative analysis on the effects of radioimmunoassay and chemiluminescence for the detection of serum HCG

Objective To investigate and analyze the effect of radioimmunoassay (RIA) and Chemiluminescence (CL) for the detection of serum HCG.Methods 100 cases from obstetrics and gynecology department were divided into 50 cases of ectopic pregnancy,30 cases of hydatidiform mole,and 20 cases of choriocarcinoma in three groups,with other 35 cases of normal control group.The experiment took advantage of RIA and ECL to measure serum HCG of four groups.Results Minimum detection value of RIA was ectopic pregnancy,80.1 mIU/ml.Highest detection value of CL was choriocarcinoma,978.9 mIU/ml.The detection value of three groups were higher than those of control group.Detection specificity of CL was 100％,higher than that of RIA(P＜0.05).Conclusion The specificity of ECL is higher than RIA and ELC with more significant effect. Key words: Radioimmunoassay; Chemiluminescence; Serum HCG

A 37⁃year⁃old woman with a history of choriocarcinoma developed severe headache vomiting and extremities numbness

A 37⁃year⁃old woman with a history of choriocarcinoma developed severe headache vomiting and extremities numbness

A case of primary gastric choriocarcinoma and a review of the Turkish literature: An extremely rare carcinoma of the stomach

Primer mide koryokarsinomu son derece nadir ve yuksek derecede malign bir tumordur. 60 yasinda bir erkek, mide agrisi ve siyah diskilama sikayetleri ile baska bir hastaneye basvurmustu. Ust gastrointestinal endoskopide mide kor-pusu ve antrumu dolduran ulserovejetan buyuk bir tumor gorulmustu. Endoskopik biyopsi ile mide adenokarsinomu tanisi konulmustu. Hasta tedavi icin hastanemize kabul edildi. Kanama ile komplike olmus mide adenokarsinomu ola-rak degerlendirildi. Cerrahi gozlemde mide korpusundan kaynaklanan kitlenin transvers kolon ve pankreasa invaze oldugu goruldu. Colyak aksta konglomere lenfadenopatiler vardi ve colyak damarlari invaze etmis idi. Palyasyon icin subtotal gastrektomi ve genisletilmis sag hemikolektomi yapildi. Patolojik incelemede sitotrofoblastlar ve sinsityotro-foblastlardan olusan iki hucre paterninin tipik ozellikleri goruldu. Tumor sadece koryokarsinomdan ibaretti. Koryokar-sinom kesin tanisi icin immunohistokimyasal testler yapildi. Beta-HCG ve EMA boyama pozitifti. Hasta ameliyattan 3 hafta sonra mide koryokarsinomu tanisi nedeniyle kontrole cagrildi. Serum beta-HCG duzeyi458 mIU/mL idi (normal aralik,

Clinical analysis of 15 cases of malignant ovarian germ cell tumors with lung metastasis

To investigate the clinical characteristics, diagnosis, treatment and prognosis of malignant ovarian germ cell tumors (MOGCT) with lung metastasis. Fifteen patients of MOGCT with lung metastasis treated in Peking Union Medical College Hospital from Jan. 1982 to Dec. 2010 was retrospectively analyzed. (1) Clinical characteristics: the average onset age of these 15 patients is (23 ± 11) years old (6 - 48 years). The majority of these patients presented with abdominal pain (8/15) or irregular vaginal bleeding (4/15) as their initial symptoms. The primary tumor located in the left ovary in 8 cases, right ovary in 6 cases, and both sides in only 1 case. Metastatic lesions were confined to the lung in 12 patients, while the other 3 patients were found to have multi-site distant metastasis. (2) DIAGNOSIS:all 15 cases included 9 pure non-gestational ovarian choriocarcinoma (NGOC), 3 MOGCT containing choriocarcinoma component (one mature teratoma with choriocarcinoma component, one endodermal sinus tumor with embryonal carcinoma and choriocarcinoma components, one choriocarcinoma with dysgerminoma component), 2 embryonal carcinoma, one immature teratoma. Only one patient in these 15 cases was correctly diagnosed before surgery. (3) Time of lung metastasis:of 12 MOGCT with choriocarcinoma component, 11 patients were found to have lung metastasis in the course of their primary treatment, only 1 had lung metastasis 2 months after the synthetic treatment finished. Three MOGCT patients without choriocarcinoma component were all found to have lung metastasis when tumor relapsed in the advanced stages of the disease. (4) TREATMENT:all 15 patients received multi-agent chemotherapy combined with surgery. The mean courses of chemotherapy for these patients were 16 courses (5 - 43 courses). (5) PROGNOSIS: of these 15 cases, complete remission was obtained in 10 patients of NGOC or mixed ovarian germ cell tumors with choriocarcinoma component, 3 patients (one NGOC, one endodermal carcinoma and one immature teratoma, respectively) died in the course of treatment as result of tumor progression, 2 progressed cases (one NGOC and one endodermal carcinoma respectively) abandoning therapy were lost to follow up. MOGCT with lung metastasis are more often to found in NGOC patients. These patients could obtain high complete remission rate after standard multi-agent chemotherapy combined with surgery. The prognosis of MOGCT with lung metastasis containing choriocarcinoma component are better than that of those without containing choriocarcinoma component.