Primary Gastric Choriocarcinoma Research Articles

A Resected Case of Primary Gastric Choriocarcinoma with Simultaneous Liver Metastasis

A Resected Case of Primary Gastric Choriocarcinoma with Simultaneous Liver Metastasis

A Rare Gastric Tumor, Primary Gastric Choriocarcinoma, Case Report

Choriocarcinoma is an aggressive neoplasm that occurs in both men and women. Primary gastric choriocarcinomas, on the other hand, have been rarely reported in the literature, mostly as mixed type carcinomas associated with gastric adenocarcinomas. Primary gastric choriocarcinomas constitute approximately 0.08% of all gastric cancers. Their prognosis is worse than gastric adenocarcinomas. In most cases, the detected cases are metastatic or locally advanced. Diagnosis with endoscopic biopsies is difficult. The diagnosis is usually made when the surgical specimens are examined. In this case presentation; We aimed to present a case of primary gastric choriocarcinoma that metastasized to the liver and regional lymph nodes.

A Positive Urine Pregnancy Test Leads to a Diagnosis of Primary Gastric Choriocarcinoma: Describing a Diagnostic Dilemma

A Positive Urine Pregnancy Test Leads to a Diagnosis of Primary Gastric Choriocarcinoma: Describing a Diagnostic Dilemma

ODP278 A rare case of Ectopic ACTH secretion associated with Primary Gastric Choriocarcinoma

Abstract Background Ectopic ACTH production contributes to 10-15% of cases of Cushing's syndrome. Most cases are caused by neuroendocrine tumors of the lung, pancreas, or thymus. Other rare tumors causing ectopic ACTH secretion include esophageal tumor, gastric carcinoid tumor and squamous cell carcinoma of the larynx (1). We present a rare case of ectopic ACTH production causing Cushing syndrome due to primary gastric choriocarcinoma. Case Presentation A 27-year-old lady, not known to have any chronic illnesses, presented with two days history of epigastric pain. The patient also reported facial puffiness, leg swelling, generalized weakness and oligomenorrhea for the last four months. There was no history of easy bruisability or weight. She was not taking any medications. The patient did not smoke or use alcohol. Physical examination revealed conjunctival pallor, facial acne, wide striae on her thighs and hepatomegaly. The rest of the examination was normal. Lab tests showed microcytic anemia with hemoglobin of 7 gm/dl (12-15 gm/dl), hypokalemia (2.5 mmol/L; normal 3.5-5.3 mmol/L), AST 38 U/L (0-40 U/L) and ALT 45 U/L (0-41 U/L). β HCG was 1,506 mIU/mL (0 -5 mIU/ml). An abdominal ultrasound showed hepatomegaly with multiple echogenic solid mass lesions suspicious of metastatic origin. A CT abdomen showed a solid lesion in the fundal region of the stomach with multiple liver metastases and moderate ascites. An esophagogastroduodenoscopy showed fungating mass originating from the stomach fundus. Biopsy of the gastric mass revealed primary gastric adenocarcinoma, which was positive forCK 7, CK 19, beta hCG, CDX2 and CEA, consistent with the diagnosis of primary gastric choriocarcinoma. Due to widespread metastasis, the patient was started on palliative chemotherapy with dexamethasone 2 mg injection once daily along with capecitabine, cisplatin and pembrolizumab. In view of persistent hypokalemia and physical examination findings, a workup for Cushing's syndrome was performed. Early-morning serum cortisol was 1054 nmol/L (138–689 nmol/L), and plasma ACTH was 174 pg/ml (7.2-63.3 pg/ml) despite the patient being on intravenous 2 mg dexamethasone once daily for more than ten days. An MRI of the brain showed a normal pituitary gland. Based on these findings, the patient was diagnosed with Cushing's syndrome due to ectopic ACTH secretion. Unfortunately, her hospital course was complicated by massive upper gastrointestinal bleeding from the tumor, leading to her demise. Conclusion Gastric choriocarcinoma is a rare tumor associated with ectopic ACTH secretion leading to Cushing's syndrome. Reference: Imura H, Matsukura S, Yamamoto H, Hirata Y, Nakai Y. Studies on ectopic ACTH-producing tumors. II. Clinical and biochemical features of 30 cases. Cancer. 1975 May;35(5): 1430-7 Presentation: No date and time listed

Severe thyrotoxicosis as initial presentation of gastric choriocarcinoma: a case report

BackgroundExtragonadal choriocarcinoma is rare and can be associated with hyperthyroidism when producing very high levels of human chorionic gonadotropin.Case presentationA 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.ConclusionsSevere 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.

Primary gastric choriocarcinoma: a rare and aggressive gastrointestinal malignancy.

A 40-year-old male with no previous medical history presented to emergency department with a 2-week history of progressive dyspnea. He also described night sweats and weight loss (15 kg) during the last 3 months. Thoraco-abdominal computed tomography showed multiple bilateral lung nodules associated with supra-clavicular, hilar and peri-esophageal lymphadenopathies and gastric parietal thickening. These imaging features were suggestive of primary gastric cancer with lung and lymph node metastases. Therefore, he undergone upper digestive endoscopy that showed a large ulcerated protruding lesion at the greater curvature of the body suggestive of malignancy. Gastric biopsies of the lesion confirmed a solid neoplasia constituted by solid nests and sheets of highly pleomorphic, bizarre cells with cytotrophoblastic and syncytiotrophoblastic differentiation that, on immunohistochemistry, stained positive for β-HCG, SALL-4 and glypican-3. CT-guided biopsy of lung nodules revealed malignant cells with similar histopathological and immunohistochemical features. Elevated serum alpha-fetoprotein and β-HCG were also detected. Clinical and ultrasound examination were negative for testicular masses. These findings were consistent with a primary gastric choriocarcinoma presenting with lung and lymph node metastases (stage IV). Although chemotherapy was started, the patient evolved unfavorably and died after 9 months. Primary gastric choriocarcinoma is a rare and aggressive gastrointestinal malignancy. This case demonstrates its rapid growth rate and high metastatic potential that may lead to symptoms from secondary involvement of distant organs.

Primary gastric choriocarcinoma.

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.

Primary gastric choriocarcinoma: a case report

Primary gastric choriocarcinoma (PGC) is an uncommon tumor. Due to its rarity, its pathogenesis is still unclear. The diagnosis is based on immunohistopathology, which is positive for human chorionic gonadotropin (hCG). It is a highly invasive and rapidly-disseminated hematogenous neoplasm, which leads to a poor prognosis. We present the case ofa 57-year-old woman with upper gastrointestinal bleeding associated with weight loss. The gastroscopy showed, on the cardia and paracardial region, a 5x4-cm ulcerated polypoid lesion with circumscribed edges and without adjacent wall infiltration, with stigmas of recent bleeding and a pathological anatomy that demonstrates ulcerated pleomorphicmalignancy with positive immunohistochemistry for pankeratin. Given the suspicion of poorly differentiated carcinoma and without evidence of metastasis, the patient underwent a total gastrectomy and the pathology was compatible with choriocarcinoma. Therefore, after the surgery, a serum hCG test was performed with a result of 714 mIU/ml, whichfurther confirmed the diagnosis. Treatment with adjuvant chemotherapy was decided, and a tomographic and serological hCG follow-up was conducted, without the presence of active disease.

Management of primary gastric choriocarcinoma with haematogenous metastases. A case report

Background: Primary gastric choriocarcinoma is an extremely rare tumour, with a prevalence of 0.8% among stomach cancers. It is an aggressive disease that progresses and rapidly metastasizes with survival expectancy between 6 and 12 months without treatment. The management is controversial as it does not respond to the usual chemotherapy lines used on gastrointestinal cancer and its treatment is not standardized due to the shortage of cases on record, so it must be individualized.

Biphasic gastric adeno-choriocarcinoma in a patient with known lynch syndrome – A case report

Primary gastric choriocarcinoma is a rare aggressive tumour accounting for less than 0.1% of all cases of gastric cancer. The majority of reported cases possess an adenocarcinoma component. Here we report a 46-year-old woman with known Lynch syndrome with MLH1 germline mutation, and a history of descending colon mucinous adenocarcinoma at age 39 presenting with a gastric tumour with multiple liver metastases and a solitary lung metastasis. Serum beta-hCG and CEA were markedly elevated at 185,000 U/L and 101.7 μg/L, respectively. Biopsy of the tumour showed a poorly differentiated biphasic carcinoma comprising 50% adenocarcinoma and 50% choriocarcinoma components. Adenocarcinoma was positive for CK7, CDX2, and Villin, whereas choriocarcinoma was positive for CK7, hCG, and p40. Interestingly, whilst the choriocarcinoma component showed loss of MLH1 and PMS2, the adenocarcinoma component showed normal mismatch repair protein immunohistochemistry. The patient subsequently underwent palliative radiation therapy. To the best of our knowledge, this is the first case of Lynch syndrome associated gastric cancer with an unequivocal choriocarcinoma component. The differential pattern of mismatch repair protein expression suggests early clonal separation of cancer progenitor cells during tumorigenesis.

Clinicopathologic characteristics of primary gastric choriocarcinoma: report of a case

Clinicopathologic characteristics of primary gastric choriocarcinoma: report of a case

術後長期無再発生存中の胃原発絨毛癌の1例

術後長期無再発生存中の胃原発絨毛癌の1例

A Case of Intraabdominal Hemorrhage from Liver Metastasis from Primary Gastric Choriocarcinoma

A Case of Intraabdominal Hemorrhage from Liver Metastasis from Primary Gastric Choriocarcinoma

Pathological Complete Response and Two-year Disease-free Survival in a Primary Gastric Choriocarcinoma Patient with Advanced Liver Metastases Treated with Germ Cell Tumor-based Chemotherapy: A Case Report

Choriocarcinoma is an early metastasizing and highly invasive tumor and characterized as a high-level human chorionic gonadotropin-secreting tumor. It normally arises in the gestational trophoblast, gonads and much less frequently in the stomach. Primary gastric choriocarcinoma appears to have a poor prognosis; especially with liver metastasis, the survival period is expected to be <1 month. This unfavorable clinical outcome is partly due to the lack of defined chemotherapy against primary gastric choriocarcinoma. We herein report a case of a 68-year-old male primary gastric choriocarcinoma patient with advanced liver metastases in which germ cell tumor-based chemotherapy achieved a pathological complete response and 2-year disease-free survival.

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,

A case of primary gastric choriocarcinoma

A case of primary gastric choriocarcinoma

A Coexistent Case of Primary Gastric Choriocarcinoma and Alpha Fetoprotein-producing Gastric Cancer which Caused Rapid Postoperative Progression

症例は78歳女性で，検診で胃上部に低分化腺癌を指摘された．上部消化管造影検査，上部消化管内視鏡検査，腹部CTで胃上部小彎に広範な腫瘍を認めた．術前血清AFP値が166ng/mlと高値を示した．胃全摘術，膵体尾・脾合併切除術を施行した．病理組織学的診断ではpT2N2M0，Stage IIIA，絨毛癌と卵黄嚢腫瘍様AFP産生胃癌の両組織を認めた．術後易感染状態を来し，感染性心内膜炎により術後48日目に永眠された．剖検診断では肝内門脈内に微小腫瘍塞栓を認めたが，そのほかには癌の転移再発所見を認めなかった．縫合不全や腹腔内膿瘍の所見も認めなかった．胃原発絨毛癌はきわめてまれで悪性度の高い疾患であるが，AFP産生胃癌との合併例はさらに稀少である．また，画像上検出されなかった微小門脈腫瘍栓が剖検で認められたことから，今後の治療計画を立てるうえでの示唆に富む症例と考えられたので報告を行った．

Co-Existent Primary Choriocarcinoma and Adenocarcinoma in the Stomach

Choriocarcinoma is an intrauterine and gestational related invasive tumour. Primary choriocarcinoma in parenchymal organ specially in gastrointestinal tract are rare. A case of Primary Gastric Choriocarcinoma (PGC) associated with adenocarcinoma in a 27 years old woman is being reported. A 27 year old lady complained of frequent passage of black tarry stool and generalized weakness for 10 days. Upper GI endoscopy revealed an ulcerated lesion in the stomach which was later confirmed as choriocarcinoma associated with adenocarcinoma by histopathological examination and serum beta-hcg (â-hcg)level estimation.

Allelic loss of the PTEN gene and mutation of the TP53 gene in choriocarcinoma arising from gastric adenocarcinoma: analysis of loss of heterozygosity in two male patients with extragonadal choriocarcinoma

A tumor suppressor gene at 10q23.3, designated PTEN, encoding a dual-specificity phosphatase with lipid and protein phosphatase activity, has been shown to play an essential role in the pathogenesis of a variety of human cancers. Frequent mutations and deletions of PTEN genes are found in cancer. Little is known, however, about the role that PTEN plays in the pathogenesis of a primary choriocarcinoma derived from gastric adenocarcinoma, an extremely rare choriocarcinoma, or in extragonadal retroperitoneal choriocarcinoma. In this study, genetic alterations occurring in extragonadal choriocarcinoma in two Japanese male patients were examined. Loss of heterozygosity (LOH) analysis using a polymorphic marker of the PTEN gene, IVS4 + 109ins/delTCTTA, revealed a hemizygous deletion of PTEN not only in the primary gastric choriocarcinoma, but also in the gastric adenocarcinoma. Microsatellite marker D12S1051 likewise showed LOH in both the primary gastric choriocarcinoma and the gastric adenocarcinoma. Mutational analysis of the TP53 gene revealed a point mutation in exon 5 (A536G), which resulted in H179R in the gastric choriocarcinoma but not in the gastric adenocarcinoma. No LOH was found for PTEN in an extragonadal retroperitoneal choriocarcinoma. Microsatellite marker D9S162 showed LOH in the extragonadal retroperitoneal choriocarcinoma, but not in the primary gastric choriocarcinoma. These results indicate that LOH of the PTEN gene and of D12S1051 is the molecular pathogenesis of the gastric adenocarcinoma, and the mutation of the TP53 gene is an additional hit for the oncogenesis of choriocarcinoma arising from gastric adenocarcinoma. However, LOH of the PTEN gene is not a common molecular event for pathogenesis of extragonadal choriocarcinoma. In addition, it was found that expression of PTEN is significantly decreased in the nuclei of syncytiotrophoblast-like cancer cells, compared with those of cytotrophoblast-like cancer cells in choriocarcinoma.

Coexistent gastric primary choriocarcinoma and adenocarcinoma

Choriocarcinomas are commonly gestational and intrauterine or gonadal in origin. Nongestational and extragonadal disease, especially in the stomach is extremely rare with a poorer prognosis and early metastasis. We herein describe a case of primary gastric choriocarcinoma with liver metastasis in a 69-year-old male. The patient presented with abdominal pain and irregular bowel habits of one month duration. Both endoscopic and radiographic imaging revealed an ulcerated and necrotic circumferential tumor in the pyloric antrum of the stomach. The histopathologic findings of the resected tumor were that of an extensively necrotic and hemorrhagic neoplasm with combined choriocarcinomatous and adenocarcinomatous element. A strongly positive immunohistochemical staining for beta- subunit of human chorionic gonadotropin (beta-HCG) in the choriocarcinomatous component and a proper correlation with elevated serum beta-HCG levels confirmed the diagnosis.