Primary choriocarcinoma of the lung: a case report and literature review

Abstract

Choriocarcinoma is a highly aggressive malignant germ cell tumor containing syncytiotrophoblasts and secreting β-hCG with a poor prognosis. Most of the choriocarcinomas are associated with gestational events and occur in the female genital tract. Primary choriocarcinoma of the lung is extremely rare and fewer than 30 cases have been reported to date. Here we report a surgically treated case of primary pulmonary choriocarcinoma in a 37-year-old woman. Surgery was followed by chemotherapy with bleomycin, etoposide, and cisplatinum. The patient was alive at 3-year follow-up and was in good condition.

Keywords: Choriocarcinoma; human β-hCG; lung.

Figure 1

Chest CT (lung window setting) showed a huge 16 × 14 cm tumor mass in the right lung (arrow).

Figure 2

(A) Hemotoxylin and eosin (H&E) stain of the right lung tumor showed sheets of highly pleomorphic tumor cells with hyperchromatic nuclei and large areas of hemorrhage and tumor necrosis (bottom) (100 ×). (B) Higher magnification of tumor showed a large, hyperchromatic multinucleated syncytiotrophoblast (arrow) and surrounding mononuclear cytotrophoblasts and intermediate trophoblasts (200 ×, H&E stain). Immunohistochemical stains for squamous cell carcinoma marker P40 (C), and adenocarcinoma marker TTF-1 (D) were negative in tumor cells. Tumor cells were immunoreactive for cytokeratin AE1/AE3 (E), diffuse strongly positive for β-hCG (F), trophoblastic marker HSD3B1 (G), and germ cell marker SALL4 (H) (200 ×).