A 32-year-old man, previously healthy, presented with chest pain, hypermastia and weight loss. The chest X-ray showed a right-sided mass continuous to the mediastinum and multiple pulmonary well-defined opacities. These findings were confirmed by CT-scan (Fig. 1). Transthoracic needle biopsy was inconclusive. A biopsy from both mediastinal and pulmonary lesions was done by video-assisted thoracoscopic surgery. The immunohistochemical staining was positive for human chorionic gonadotropin (hCG) and CK7. Serum tumor markers documented a high level of serum hCG (>100,000mUl/mL; normal 0–5). A diagnosis of primary mediastinal choriocarcinoma was made based upon immunohistochemical staining and absence of other lesions. Patient started treatment with bleomycin, etoposide and cisplatin.
(A) Thoracic X-ray showing a heterogenous right-sided mass continuous to the mediastinum (black arrow) and multiple pulmonary well-defined opacities (white arrows); (B) Coronal section on thoracic CT-scan showing a heterogeneous solid mediastinal mass (black arrow), touching the right atrium and diaphragm, and two pulmonary solid nodules on the left lung (white arrows); (C) Axial section on thoracic CT-scan presenting the anterior mediastinal mass (black arrow) contacting the ascending aorta, and left and right pulmonary nodules suggesting various metastasis (white arrows).
Choriocarcinoma is a very rare neoplasm. There are two forms: gestational and non-gestational. Non-gestational choriocarcinomas can form in males usually between ages 20 and 30, in the gonads or midline structures with pluripotent germ cells.1 It usually presents with atypical symptoms, multiple metastases in early stages, poor response to therapy and decreased survival.2 Increased serum levels of hCG are associated with worse prognosis.1,2 Diagnosis requires histological and immunohistochemical analysis of the tumor.2 This case highlights the relevance of keeping primary choriocarcinoma in the differential diagnosis of mediastinum tumors.
Conflict of interestNone.
