Primary choriocarcinoma of the liver: a clinicopathological study of five cases in males

Abstract

Primary choriocarcinomas of the liver are rare. Previous reported cases were mostly in infants with only rare adult cases. Here, we presented five adult cases. The patients were all males, with an average age of 41.6 years (from 36 to 48 years). Clinical presentations included right upper abdominal pain or abdominal distension. All patients presented with a large hepatic mass on ultrasonography that measured 11 cm on average in the greatest diameter. Elevated serum human chorionic gonadotropin (HCG) levels were noted in all cases. At presentation, the tumor was confined to the liver in two patients and therefore surgically resected. The other three patients presented with extrahepatic metastases on imaging study and therefore only received chemotherapy. All five patients died from the tumor within 2 to 8 months. Autopsy was performed for all five cases. The autopsy confirmed that the choriocarcinoma was confined to the liver in two surgically resected cases. The other three patients had metastatic choriocarcinoma in the lung (two patients), peritoneum (one patient), adrenal glands (one patient), and brain (one patient). None of the patients had any evidence of a testicular tumor or scar after examination of the entirely submitted testes. No tumor was observed in central nervous system, mediastinum, or other organs other than described above. Grossly, the primary tumors were large, soft, hemorrhagic, and with foci of necrosis. Histologically, the tumors were composed of mononucleated trophoblastic cells with round nuclei, clear cytoplasm, and prominent nucleoli admixed with large, multinucleated syncytiotrophoblastic cells. Immunohistochemically, tumor cells were strongly positive for keratin, HCG, and focally positive for human placental lactogen. Ki-67 proliferation index was high (mean 75%) in the mononucleated trophoblastic cells. Our series is the largest one to document primary hepatic choriocarcinoma in adults. Although these tumors are rare, they behave in a very aggressive fashion.

Primary Hepatic Choriocarcinoma: A Rare Cause of Spontaneous Haemoperitoneum in an Adult

“…Average survival being 2 to 8 months 7 as reported in literature, hence further studies are needed for early diagnosis and better treatment to improve survival.…”

“…Immunoshistochemical staining for beta HCG, PLAP, HPL, Hepar-1, may aid the diagnosis and helps to differentiate from the other tumours which mimic choriocarcinoma like giant cell variant of poorly differentiated hepatocellular carcinoma, or tumor with trophoblast like giant cells. 7 Finally imaging modalities like ultrasonography and CT scan may be useful to assess the extent of primary tumour and metastasis to various organs.…”

Primary choriocarcinoma of the posterior mediastinum in a male: A case report and review of the literature

“…Primary choriocarcinoma is an unusual neoplasm of the posterior mediastinum, which frequently occurs in the gonads and uterus, and less frequently in the extragonadal sites (1). There are several theories regarding the development of primary mediastinal choriocarcinoma, including abnormal germ migration (2) and tumor cell distortion (3).…”

“…However, the precise genetic mechanism remains unknown. The majority of cases are misdiagnosed by imaging examination and clinical features prior to surgery (1). Chemotherapy, radiotherapy and surgery are the main therapeutic strategies, however, the effect of any method of treatment is poor.…”

Gallbladder adenocarcinoma with human chorionic gonadotropin: a case report and review of literature

“…In other organs, most of the cases with HCG positive, non-gestational tumors have been reported as non-gestational choriocarcincoma in the gastrointestinal tract such as stomach [7-10], esophagus [11], colon [12,13] and jejunum [14]. Other sites such as brain [15], lung [16,17] and liver [18] have also been reported. In addition to the tumor with choriocarcinomatous elements, ectopic production of HCG by gastrointestinal tract tumors has also been reported by many authors either by using radioimmunoassay [19-22] or by immunohistochemical stain techniques [23-26].…”