Biochemical remission by chemoradiotherapy in male mediastinal choriocarcinoma with diffuse lung metastasis: A case report

Abstract

Abstract. Primary mediastinal choriocarcinoma is a rare malignancy that is characterized by multiple metastases at the time of diagnosis, poor response to therapy and short survival times. There is no standard treatment for this disease. The present study described the case of a 25-year-old man with metastatic mediastinal choriocarcinoma. The patient completed 8 cycles of standard combination chemotherapy consisting of etoposide [100 mg/m 2 ; intravenous (IV) drip on days 1-3], cisplatin (20 mg/m 2 ; IV drip on days 1-5) and bleomycin (20 mg/m 2 ; intramuscular injection on days 1, 8 and 15 every 21 days). The α-fetoprotein level decreased to 2.36 ng/ml, the serum β-human chorionic gonadotropin (β-HCG) level markedly decreased to 8.69 IU/l, which was slightly higher than the normal upper limit, and the lactate dehydrogenase level decreased to a normal range. The computed tomography (CT) scan revealed that the number and size of the lung lesions was significantly reduced subsequent to 8 cycles of chemotherapy and the size of the mediastinal tumor was evidently reduced, with a less solid component and a more cystic component. The response assessment indicated partial remission. Following chemotherapy, a radiation dose of 50 Gy (2.0 Gy/fraction) was administered to the involved field of the mediastinum. Following radiotherapy, the β-HCG level had also decreased to normal levels, and CT evaluation revealed that the size of the residual lung lesions demonstrated no evident change, and the mediastinal tumor was slightly reduced in size, with a less solid component. The patient refused to undergo surgery and did not receive additional treatment following radiotherapy. At present, the patient has survived >16 months of follow-up without any symptoms.

Primary mediastinal choriocarcinoma in a female patient: Case report and review of the literature

“…The mechanism by which primary mediastinal non-gestational choriocarcinoma develops is poorly understood. Postulated theories include: (1) metastases from a primary gonadal choriocarcinoma that regressed spontaneously; (2) origin from a trophoblastic embolus related to a gestational event after a long period of latency; or (3) origin from retained primordial germ cells that migrated abnormally during embryogenesis ( Fine et al, 1962 ; Br Med, 1969 ; Cohen and Needle, 1975 ; Forest et al, 1977 ; Lam et al, 2011 ; Zhang et al, 2014a ; 2014b ; Kuno et al, 2016 ; Zhang et al, 2016 ; Francischetti et al, 2017 ).…”

Mediastinal Germ Cell Tumors: A Review and Update on Pathologic, Clinical, and Molecular Features

“…Pure choriocarcinoma primary to the mediastinum is a rare diagnosis, yet several case reports and small series describe cases with similar histologic features to tumors at more common sites of choriocarcinoma. [91][92][93][94][95][96][97][98][99][100][101][102] Like other mediastinal GCTs, histologic findings (Fig. 4) between sites are thus indistinguishable.…”

“…Case series and reports including immunohistochemical analysis of pure mediastinal choriocarcinoma 56,60,[91][92][93][95][96][97][98][99][100][101][103][104][105] have shown consistent hCG and pancytokeratin immunoreactivity. Conversely, AFP, PLAP, CD30, vimentin, CEA, OCT3/4, c-kit (CD117), and CK5/6, and TTF-1 were consistently negative.…”

Male primary mediastinal choriocarcinoma with diffuse metastases

“…Choriocarcinoma is a rare trophoblastic malignancy characterized by poorly differentiated tumor cells, early hematogenous metastasis to multiple organs, increased β-human chorionic gonadotropin (β-hCG), and well responsiveness to chemotherapy. [1,2] Choriocarcinoma is subdivided by origin and primary site into gestational and non-gestational choriocarcinoma. The latter is also called extragonadal choriocarcinoma or primary choriocarcinoma (PCC).…”

“…The standard therapy of mediastinal PCC has not been established. [2] Locoregional radiotherapy and surgery can be used for early stages together with aggressive chemotherapy, while later stages have already missed the locoregional therapy. [19] The prognosis is extremely poor, [19] and the majority of patients succumb within a short follow-up time (Table 1).…”