Year 2023 / Volume 115 / Number 10
Letter
Primary gastric choriocarcinoma: a rare and aggressive gastrointestinal malignancy

585-586

DOI: 10.17235/reed.2022.9433/2022

Emanuel Dias, João Santos-Antunes, Raquel Portugal, Jorge Pinheiro, Fátima Carneiro, Guilherme Macedo,

Abstract
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.
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References
1. Hirotsu A, Hiramatsu Y, Kawata S, et al. Rapid recurrence of primary gastric choriocarcinoma after complete resection. Int J Surg Case Rep. 2019;57:138-41.
2. Lee JH, Lee JK, Kang DB. Primary Gastric Choriocarcinoma Coexisting with Adenocarcinoma. Korean J Gastroenterol. 2019;73(6):350-4.
3. Liu Z, Mira JL, Cruz-Caudillo JC. Primary gastric choriocarcinoma: a case report and review of the literature. Arch Pathol Lab Med. 2001;125(12):1601-4.
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Dias E, Santos-Antunes J, Portugal R, Pinheiro J, Carneiro F, Macedo G, et all. Primary gastric choriocarcinoma: a rare and aggressive gastrointestinal malignancy. 9433/2022


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Publication history

Received: 17/12/2022

Accepted: 20/12/2022

Online First: 12/01/2023

Published: 09/10/2023

Article Online First time: 26 days

Article editing time: 296 days


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