Two Unusual Presentations of Gestational Trophoblastic Neoplasia: Cutaneous Metastasis and a Large Solitary Lung Lesion

Gestational trophoblastic tumors, an uncommon group of pregnancy-related neoplasms, should be considered in any premenopausal patient presenting with metastatic disease from an unknown primary. A raised hCG and exclusion of pregnancy are often the only requirement in this situation. Although a potentially curable condition, a late diagnosis and the extent of the metastatic disease often determine the prognosis. Here we describe two young women with metastatic GTN, the first presenting with a very unusual finger metastasis and the second with a rare large solitary lung lesion with brain metastasis.

Treatment outcome of gestational trophoblastic neoplasia patients in Egypt

Background: Gestational trophoblastic neoplasia (GTN) are a spectrum of tumors that develop from placental tissue. We aimed to evaluate the management and treatment outcome of GTN. Methods: Patients diagnosed with GTN presented to Kasr Alainy Center of Clinical Oncology between 2008 and 2017 were included in this study. Patients were assigned to low or high-risk according to the World Health Organization (WHO) scoring system. All data were tabulated and statistically studied by descriptive analysis; comparison between the two groups was done using student t-test for continuous data and Chi-square test for categorical data. Results: A total of 111 patients were studied; the majority of them had WHO low-risk score. In low-risk group, the overall response rate to methotrexate-folinic acid (MTX- FA) or actinomycin D (ActD) was 48.5%, comparable response rate observed between MTX and ActD was 48.2% vs 50%, respectively. Those who received MTX-FA 8-day regimen had higher response rate compared to a weekly schedule, however, no statistical significant difference was observed (51.6% vs 44.4%, respectively, P = 0.586), all low-risk patients who failed MTX or ActD achieved complete remission (CR) with subsequent chemotherapy. Patients with WHO score 5–6 had a significantly lower CR rate compared to patients with scores <5, (28% and 60%, respectively; P = 0.01). Five-years overall survival was significantly lower in high-risk than low-risk patients (79.3% vs 100%, respectively, P = <0.001). Conclusion: Low-risk patients have a survival rate of 100% even if they did not respond to first-line chemotherapy, MTX-FA 8-day regimen seems to be more effective than MTX weekly regimen.

Coriocarcinoma primario de estómago. Reporte de un caso / Primary choriocarcinoma of the stomach. A case report

RESUMEN El corioadenocarcinoma gástrico primario (PGC) constituye menos del 1% de todos los cánceres gástricos; es más común en los hombres. Aproximadamente un tercio de los pacientes ya tienen enfermedad metastásica en el momento del diagnóstico. Presentamos el caso de un paciente varón de 70 años, diagnosticado de adenocarcinoma gástrico en antropíloro, al que se le realizó gastrectomía radical distal. El diagnóstico anatomopatológico muestra un adenocarcinoma, con un 85% de diferenciación coriocarcinomatosa, un 10% con áreas de adenocarcinoma tubular y el 5% restante por componente sugestivo de tumor de saco vitelino. Nuestro paciente logró una sobrevida de 5 meses después de la cirugía, durante este tiempo estuvo en seguimiento por medicina oncológica con quimioterapia. Esta enfermedad sigue teniendo un pronóstico sombrío; menor a 6 meses.

ABSTRACT Primary gastric chorioadenocarcinoma (PGC) constitutes less than 1% of all gastric cancers; it is more common in men. Approximately one third of patients already have metastatic disease at the time of diagnosis. We present the case of a 70-yearold male patient, diagnosed as gastric adenocarcinoma in anthropylorus, who underwent radical distal gastrectomy. The pathological diagnosis shows an adenocarcinoma, with 85% choriocarcinomatous differentiation, 10% with areas of tubular adenocarcinoma and the remaining 5% per component suggestive of yolk sac tumor. Our patient achieved a survival of 5 months after surgery, during this time he was followed up by oncology medicine with chemotherapy. This disease continues to have a gloomy prognosis; less than 6 months.

Difficulty in Diagnosing of Renal Choriocarcinoma: Case Report / Dificuldade no diagnóstico do coriocarcinoma renal: relato de caso

ABSTRACT Choriocarcinoma is a rare highly malignant tumor. We report a case of 35-year-old woman, with a history of four months menstrual irregularity and human chorionic gonadotropin persistently positive that presented transvaginal ultrasound normal and the computed tomography scan of the chest showed three nodules and abdominal scan evinced a hypervascularized solid nodular lesion on left kidney. An ultrasound-guided biopsy of left kidney was performed with a pathologic diagnosis of renal choriocarcinoma. After chemotherapy the human chorionic gonadotropin was negative and the patient returned to normal menstrual cicles.

RESUMO O coriocarcinoma é um tumor altamente maligno raro. Relatamos um caso de mulher de 35 anos, com história de irregularidade menstrual de quatro meses e gonadotrofina coriônica humana persistentemente positiva que apresentava ultrassonografia transvaginal normal e a tomografia computadorizada de tórax com três nódulos e a abdominal evidenciava um nodular sólido hipervascularizado lesão no rim esquerdo. Uma biópsia guiada por ultrassom do rim esquerdo foi realizada com diagnóstico patológico de coriocarcinoma renal. Após a quimioterapia, a gonadotrofina coriônica humana foi negativa e a paciente retornou aos ciclos menstruais normais.

Prevalence of gestational choriocarcinoma in a parous population in ten years

Background: Choriocarcinoma is a rare disease with varying incidence in different parts of the world. Asian, American Indian and Africans are quoted to be at a higher risk. There are no epidemiological data from Middle East and hence authors studied the prevalence of choriocarcinoma in Oman, a Middle East nation with a high parity.Methods: This is a retrospective, descriptive, observational study done at tertiary care hospital; Royal Hospital from Jan 2010 to Dec 2019. Since all women are referred to a single center from all over the country, authors believe all cases are included over ten years.Results: There were 22 patients and the prevalence were 1 in 36966 live births. The main presenting symptom was abnormal uterine bleeding and all were gestational type of choriocarcinoma. Median gravidity was 6 and median parity was 5. Almost 80 % received chemo as their risk scoring was more than 7 and one woman died.Conclusions: The prevalence of choriocarcinoma was much similar to Europe and USA though the median gravidity and parity was high. Clinical features were comparable to the literature and management protocols were as per international recommendations.

Gestational Trophoblastic Diseases - A Clinicopathological Study

The term ‘gestational trophoblastic disease’, includes lesions, some of which are categorized as true neoplasms, and others that are representative of placentas that are malformed. It refers to various lesions that accompany the premalignant type, some of which are hydatidiform moles of the partial or the whole variety. The malignant type of lesions (GTD / GTN), include the following: choriocarcinoma, epithelioid trophoblastic tumour, placental site trophoblastic tumour, and invasive moles. METHODSA total number of thirty-four cases of GTD during the last two years at a tertiary care hospital was studied, relevant data was collected, and histological features studied. RESULTS79.41% of GTDs in the present study were complete mole, 58.82% of GTDs occurred in nullipara, 52.94% cases had GTDs seen in the third decade, 14.70% cases had history of previous GTD, 5.88% cases had history of previous abortion, 2.94% cases had a history of previous ectopic pregnancy, and case with choriocarcinoma had the highest HCG levels. In contrast, case with epithelioid trophoblastic tumour had the least HCG levels. CONCLUSIONSIn this particular study, it was found that most of the GTDs occurred in nulliparous women in their thirties and their occurrence increased with risk factors like a previous history of GTD, abortions, or ectopic pregnancy.

Gestational trophoblastic diseases: an observational study at a tertiary care teaching hospital in Jharkhand, India

Background: Gestational Trophoblastic Diseases (GTD) encompass a wide spectrum of proliferative disorders of trophoblast tissue, which hold a good prognosis if diagnosed and treated on time. A close understanding of the disease spectrum is therefore needed to reduce morbidity and mortality.Methods: This is an observational study (both prospective and retrospective analysis) conducted in Rajendra Institute of Medical Sciences, a tertiary care teaching hospital in Ranchi, Jharkhand over a period of 2 years from 1st January 2017 to 31st December 2018.Results: A total of 162 cases of GTD were identified during the study period. Disease spectrum comprised of complete molar pregnancy in 146 (90.12%) and partial molar pregnancy in 7 (4.3%), GTN in 9 out of 162 cases (5.5%). Bleeding per vaginum preceded by amenorrhea was the most common symptom, observed in 95.4% of the cases. Uterine size was more than period of amenorrhea in almost 50% of the cases. Theca lutein cysts were found in 39.8% of the cases, hypertension in 21.5%, hyperthyroidism in 6.5% cases. Overall, there were nine (5.56%) cases of choriocarcinoma and six (3.7%) cases of Invasive mole. Remission rate in GTN was 86.7% with chemotherapy.Conclusions: Women complaining of vaginal bleeding in first half of pregnancy with uterine size more than period of amenorrhea must be evaluated for GTD by ultrasound and serum beta HCG. For cases of molar pregnancies, suction and evacuation remains the treatment of choice but need for regular follow-up and strict compliance to contraception during entire follow up has to be emphasized. Cases of GTN have excellent remission with chemotherapy.

A profile of cases of gestational trophoblastic neoplasia at a tertiary care centre in South India

Background: Gestational trophoblastic disease (GTD) comprises a spectrum of diseases ranging from molar pregnancy to malignant gestational trophoblastic neoplasia (GTN). GTN are highly chemo-sensitive tumours which are treated as per FIGO risk stratification. The rarity of the disease limits the evidence regarding the disease to case series and reports. The objective of this study was to study incidence, baseline characteristics of patients and clinical outcome of GTN patients treated at this centre.Methods: This is a retrospective descriptive study based on medical records of patients of GTD who were registered in department of medical oncology, from January 2015 to December 2018 (4 years). GTN was diagnosed based on serum beta HCG values. Their baseline characteristics, risk score, serum β HCG levels, and treatment regimens were investigated. The incidence of GTD and response to treatment were analysed.Results: Out of 211 GTD patients, 56 developed GTN. The incidence was 3.4 per 10000 deliveries. Low risk cases (n=38) were treated with methotrexate and actinomycin in first line while high risk cases received EMACO and EP followed by EMACO as the first line. A cure rate of 100% for low risk cases and 94.4% (n=17) for high risk cases were recorded. Resistance to MTX was 32.3% while EMACO was resistant in 46.6% as first line. Neutropenia and alopecia were the most common treatment related adverse events. Predictors of resistance to single agent in low risk GTN include higher pre-treatment βHCG values and higher risk scores.Conclusions: GTN exemplifies a rare, highly aggressive but curable malignancy. Serum βHCG is the most reliable diagnostic as well as prognostic marker in management of GTD. EMACO is the preferred regimen for high risk GTN. FIGO staging and risk stratification help in individualizing the treatment to ensure maximum response to therapy thus making GTN a curable malignancy.

Abdomen agudo por coriocarcinoma accidentado. Reporte de un caso clínico / Acute abdomen by accidented coriocarcinoma. Report of a clinical case

Introducción: El coriocarcinoma es una neoplasia gestacional trofoblástica maligna que puede ocurrir después de una mola hidatiforme, embarazo ectópico, aborto e incluso de un embarazo normal. Se trata de una patología poco frecuente que en ocasiones puede pasar desapercibida. Entre las complicaciones clínicas se destaca la metástasis, pero es excepcional la ruptura uterina, siendo esta la que se presenta en el presente caso denotando la importancia del seguimiento. Presentación de caso: Paciente femenina de 49 años que presenta dolor en hipogastrio y vómito, tiene antecedente de mola hidatiforme no controlada. Examen complementario muestra beta-gonadotropina coriónica humana (B-HCG) cualitativa positiva y culdoscentesis positiva. Se realiza tratamiento quirúrgico por laparotomía exploratoria evidenciándose hemoperitoneo más tumor que perfora útero. Se realiza histerectomía abdominal total. Se confirma diagnóstico presuntivo a través de estudio histopatológico que determina coriocarcinoma. Paciente no continua con tratamiento conociéndose posteriormente su deceso. Conclusiones: Se presenta este caso por ser una patología infrecuente con una complicación poco habitual como es la ruptura uterina por coriocarcinoma, al ser considerada una rareza su importancia radica en el diagnóstico oportuno y adecuado seguimiento del caso.

Choriocarcinoma of the colon: A rare case / Philippine Journal of Obstetrics and Gynecology

@#Gestational trophoblastic neoplasia is a group of tumors which includes invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor, all of which develop after a recognized pregnancy. Choriocarcinoma is a highly invasive and metastatic neoplasm which arises in women of reproductive age. Local spread is reported at 15% while distant metastasis at 4%. Of the 4% of cases having distant metastasis, 60% goes to the lungs, 30% to the vagina, and 10% to other sites. Less than 5% of patients with metastatic gestational trophoblastic neoplasia have involvement of the gastrointestinal tract. This is the case of a 47-year-old multigravid patient who came in with an enlarging abdomen 8 years after she had a hydatidiform mole. Work-ups were done which revealed metastases to the colon, liver and lungs. The plan of management was to give multiple agent chemotherapy.

Unusual abscess masquerading as poorly differentiated adenocarcinoma of the colon showing characteristics of choriocarcinoma

Extragonadal non-gestational choriocarcinoma (ENC) is an uncommon malignant tumor occasionally found in the gastrointestinal tract. ENC is characterized by a biphasic tumor growth with distinct areas of adenocarcinoma and choriocarcinoma differentiation. Primary choriocarcinoma of the colon is extremely rare, with only 21 cases reported in the literature. Most of the perforation of colorectal cancers occurs in the abdominal cavity, while abdominal wall abscess is rare; the psoas abscess associated with colon carcinoma is even less observed. Herein, we report the case of a 61-year-old female with poorly differentiated adenocarcinoma of the ascending colon and sigmoid, with choriocarcinomatous differentiation, masquerading a psoas abscess formation. Unfortunately, despite the aggressive therapy, the patient's disease rapidly progressed, and she died within 2 months after the diagnosis. The typical morphological pattern, immunohistochemistry, and its correlation with serum β-human chorionic gonadotropin enabled a correct diagnosis.

Mola invasiva en adolescente de 13 años. Aspectos fundamentales del diagnóstico y tratamiento / Invasive mola in 13-year-old girl. Fundamental aspects in diagnosis and treatment

Resumen ANTECEDENTES: La neoplasia gestacional trofoblástica es un tumor raro, derivado de la gestación que procede de un desarrollo anormal del tejido trofoblástico. Incluye cuatro variedades, entre las que se encuentra la mola invasiva y el coriocarcinoma. Puede tener diferentes grados de proliferación; el diagnóstico diferencial es decisivo porque influye directamente en el tratamiento. Las molas premalignas suelen tratarse con legrado uterino, las malignas requieren tratamiento sistémico con mono o poliquimioterapia. CASO CLÍNICO: Paciente de 13 años, hospitalizada debido a un cuadro de vómitos y dolor abdominal. Durante el internamiento se le practicaron estudios complementarios: determinación de la fracción β de la gonadotropina coriónica humana (β-hCG) y tomografía axial computada para plantear el diagnóstico diferencial. El diagnóstico definitivo lo aportó la biopsia obtenida mediante legrado. El tratamiento se basó en la poliquimioterapia. En la actualidad está en remisión completa de la enfermedad. CONCLUSIONES: Resulta imprescindible detectar lo más temprano posible la gestación anómala, entender perfectamente su evolución e importancia de la anticoncepción mientras se trata y la enfermedad desaparece y minimizar la cantidad de pacientes que deben recibir quimioterapia.

Abstract BACKGROUND: Gestational trophoblastic neoplasia is a rare tumor that originates from pregnancy and it develop from anormal proliferation of trophoblastic tissue. It includes four varieties, including invasive mole and choriocarcinoma. They can present different degrees of proliferation, being essential differential diagnosis since it directly influences the treatment. Premalignant moles are usually treated by suction curettage while malignant forms require systemic therapy with mono or polychemotherapy. OBJECTIVE: Report the case, paying special attention to the differential diagnosis and treatment used, analyzing the reasons why polychemotherapy is established and describing the different possible options, based on current scientific evidence. CLINICAL CASE: We present the case of an invasive mola in a 13-year-old patient hospitalized by vomiting and abdominal pain. During this period, complementary techniques such as the determination of the β fraction of the human chorionic gonadotropin (β-hCG) or computed tomography (CT) are required to establish the differential diagnosis. Finally, the definitive diagnosis is provided by the biopsy obtained by curettage. Treatment is instituted with the pattern of polychemotherapy being, currently, with complete remission of the disease. CONCLUSIONS: Thus, it is essential to detect anomalous gestation early, to understand perfectly the evolution of this entity, the importance of contraception during its resolution, and to minimize patients susceptible to chemotherapy.

Hipertiroidismo como clave diagnóstica de un coriocarcinoma avanzado: Una asociación inusual / Hyperthyroidism as a diagnostic key to advanced choriocarcinoma. An unusual association

El hipertiroidismo es una condición relativamente frecuente con múltiples etiologías. La más común es la enfermedad de Graves, seguida del bocio multinodular y el adenoma tóxico. La asociación entre hipertiroidismo y cáncer es infrecuente en la práctica clínica. Presentamos el caso de un varón de 42 años con síntomas de hipertiroidismo de dos meses de evolución. Al examen físico se constató una marcada hepatomegalia de consistencia duro pétrea. El examen de testículos se reveló normal. Se llevó a cabo el diagnóstico de hipertiroidismo a través del dosaje hormonal. Los estudios por imágenes mostraron la presencia de múltiples lesiones sólidas compatibles con metástasis hepáticas. Luego de descartar las causas habituales de hipertiroidismo y las neoplasias primarias de la glándula tiroides, se consideró la posibilidad de mimetismo molecular a través de la producción ectópica de gonadotrofina coriónica humana. Se obtuvieron valores críticamente elevados de esta hormona y en un segundo tiempo se confirmó el diagnóstico histológico de coriocarcinoma a través de una biopsia hepática. Consideramos que el reconocimiento de este mecanismo poco frecuente de hipertiroidismo, puede ser una clave diagnóstica para arribar rápidamente al diagnóstico correcto, particularmente en los tumores extragonadales.

Hyperthyroidism is a relatively frequent condition with multiple causes. The most common cause is Graves' disease; followed by hyperthyroid multinodular goiter and toxic adenoma. Association between hyperthyroidism and cancer is infrequent in daily practice. We present the case of a 42-year-old man who developed severe symptoms of hyperthyroidism within a period of two months. Physical examination revealed significant hepatomegaly. Testicular examination proved normal. Imaging studies showed the presence of multiple hepatic solid lesions consistent with metastases. After discarding the most common causes of hyperthyroidism and primary thyroid gland neoplasm, the possibility of molecular mimicry was considered through human chorionic gonadotrophin production. Critical high values of this hormone were found and choriocarcinoma histological diagnosis was confirmed through a liver biopsy. We consider that the recognition of this rare mechanism of hyperthyroidism may be a clue permitting a faster diagnosis, particularly when extragonadal tumors are present.

Hemorragia intracerebral como primera manifestación de un coriocarcinoma metastásico: reporte de caso / Intracerebral hemorrhage as the first manifestation of a metastatic choriocarcinoma: case report

RESUMEN El coriocarcinoma es una variante muy vascularizada, invasiva y poco común de la enfermedad trofoblástica gestacional. Es potencialmente fatal sin tratamiento adecuado y se caracteriza por la proliferación maligna de tejido trofoblástico con una alta tasa de metástasis. Se presenta el caso de una paciente joven con hemorragia intracerebral como primera manifestación de un coriocarcinoma metástasico. Se describen las características clínicas e imagenológicas y se hace una revisión de la literatura actual, con énfasis en los detalles más relevantes respecto al diagnóstico diferencial de la hemorragia intracerebral de presentación atípica y el tratamiento más apropiado.

SUMMARY Choriocarcinoma is an invasive, highly vascularized, rare gestational trophoblastic disease. It is potentially fatal without proper treatment and is characterized by malignant proliferation of trophoblastic tissue with a high rate of metastases. We present the case of a young patient with intracerebral hemorrhage as the first manifestation of metasta-tic choriocarcinoma. We describe the clinical and imaging characteristics and review current literature, with emphasis on the most relevant details regarding the differential diagnosis of intracerebral hemorrhage atypical presentation and the most appropriate treatment.

Embolia pulmonar tumoral: un reto diagnóstico / Pulmonary tumour embolism: a diagnostic challenge

Resumen Se publica el caso de una paciente de 27 años, quien consultó al Servicio de Urgencias del Hospital Hernando Moncaleano Perdomo, por cuadro clínico de tos seca persistente que posteriormente se acompañó de disnea, dolor pleurítico y hemoptisis, de aproximadamente cuatro meses de evolución. Tenía antecedentes quirúrgicos de lipoescultura y abdominoplastia cuatro meses previos al ingreso e histerectomía hace un año (por hemorragia uterina). Mediante correlación clínico-patológica se llegó al diagnóstico de embolia pulmonar de origen tumoral, entidad aún de diagnóstico difícil dada la presentación clínica inespecífica. Para la diferenciación diagnóstica los estudios radiológicos no son precisos, a menos que se lleven a cabo procedimientos invasivos para llegar a un diagnóstico certero, como ocurrió con la paciente. Se presenta el caso y se hace una revisión sobre embolia pulmonar y sus otras causas como coriocarcinoma; adicionalmente se abarcan aspectos relevantes sobre incidencia, cuadro clínico, tratamiento y pronóstico, de una patología cuyo diagnóstico sigue siendo en su mayoría tardío.

Abstract The case is presented of a 27 year-old patient who was seen in the Emergency Department of the Hospital Hernando Moncaleano Perdomo, due to a clinical picture of a persistent dry cough that was later accompanied by dyspnoea, pleural pain, and haemoptysis, of approximately four months onset. She had a surgical history of liposculpture and abdominoplasty four months prior to the admission, and a hysterectomy a year ago (uterine haemorrhage). Using clinical-pathological correlation, the diagnosis was made of a pulmonary embolism of tumour origin, a condition still difficult to diagnose given the unspecific clinical picture. Radiological studies are not accurate for the differential diagnosis, unless invasive procedures are used to reach an accurate diagnosis, as in the case of this patient. As well as the case, a review is presented on pulmonary embolism and its other causes such as choriocarcinoma. Furthermore, relevant aspects are included on its incidence, clinical symptoms, treatment and prognosis, in a disease for which the majority of diagnoses continue to be delayed.

Primary Gastric Choriocarcinoma Coexisting with Adenocarcinoma / 대한소화기병학회잡지

Choriocarcinoma is an aggressively growing and widely metastasizing tumor that originates from trophoblastic cells. A primary gastric choriocarcinoma (PGC), however, is very rare. A 76-year-old female patient visited the emergency department of Wonkwang University Hospital with abdominal discomfort and melena. Esophagogastroduodenoscopy revealed a huge ulceroinfiltrative mass lesion with blood clots on the boundary between the greater curvature side and the posterior wall side of the stomach lower body. CT showed a 3-cm exophytic mass lesion with heterogeneous enhancement, an ulcer lesion at the posterior wall side of the stomach lower body, and multiple enlarged lymph nodes at the splenic artery and left gastric artery nodal stations. She underwent a radical subtotal gastrectomy with a D2 lymph node dissection. The final diagnosis was PGC coexisting with adenocarcinoma based on the pathology results. This paper reports a rare case of primary gastric choriocarcinoma coexisting with adenocarcinoma and discusses the characteristics of this neoplasm with reference to the literature.

Primary Gastric Choriocarcinoma Coexisting with Adenocarcinoma / 대한소화기학회지

Choriocarcinoma is an aggressively growing and widely metastasizing tumor that originates from trophoblastic cells. A primary gastric choriocarcinoma (PGC), however, is very rare. A 76-year-old female patient visited the emergency department of Wonkwang University Hospital with abdominal discomfort and melena. Esophagogastroduodenoscopy revealed a huge ulceroinfiltrative mass lesion with blood clots on the boundary between the greater curvature side and the posterior wall side of the stomach lower body. CT showed a 3-cm exophytic mass lesion with heterogeneous enhancement, an ulcer lesion at the posterior wall side of the stomach lower body, and multiple enlarged lymph nodes at the splenic artery and left gastric artery nodal stations. She underwent a radical subtotal gastrectomy with a D2 lymph node dissection. The final diagnosis was PGC coexisting with adenocarcinoma based on the pathology results. This paper reports a rare case of primary gastric choriocarcinoma coexisting with adenocarcinoma and discusses the characteristics of this neoplasm with reference to the literature.

Primary mediastinal choriocarcinoma in male: A case report and literature review / 肿瘤

Objective: To introduce the diagnosis and treatment of a case of male primary mediastinal choriocarcinoma, and to summarize the diagnosis and treatment of the disease by literature review. Methods: The diagnosis and treatment process of a male patient with primary mediastinal choriocarcinoma was reported. The clinical characteristics, diagnosis and treatment of 132 cases of primary mediastinal choriocarcinoma were retrospectively analyzed, in order to summarize the experience of diagnosis and treatment of this disease. Results: A 19-year-old male was admitted to hospital in September 2017 due to “chest pain and dyspnea for 1 week”. After 2 times of CT-guided mediastinal punctures, he was diagnosed with “choriocarcinoma”. After 8 times of chemotherapy and local radiotherapy for mediastinal and lung masses were completed in the hospital from October 2017 to March 2018, the response evaluation was partial remission. Following up to December 2018, the patient was generally in good condition, and no progression of tumor was observed; but he died in March 2019 due to suspected tumor recurrence. The literature review showed that the disease was rare in clinical practice, lacking of large-scale clinical studies and consensus on treatment options, so the median survival time of patients was generally short. Conclusion: Primary mediastinal choriocarcinoma in male is a rare disease that lacks specific clinical features. The treatment mainly relies on the comprehensive treatment including surgery, chemotherapy and radiotherapy, but the disease progresses rapidly with poor prognosis.

All-trans retinoic acid (atra) inhibits telomerase expression of BeWo choriocarcinoma cell (ATCC CCL-98)

@#Introduction: Choriocarcinoma is malignant cancer originating from placental trophoblast. The incidence of this cancer is estimated at 0.57-1.1 per 1000 births in the United States of America, Australia, Europe, and New Zealand. The rate is much higher in South East Asia and Japan with two occurrences per a thousand births. Telomerase activity is an important part of the apoptotic process. Increased telomerase activity will result in cellular immortality and poor prognosis in cancer. Vitamin A possess an essential role in cell proliferation and differentiation. One of the active metabolites of vitamin A is All-Trans Retinoic Acid (ATRA). Methods: In this study, we examined the role of ATRA against telomerase activity in choriocarcinoma cell. This cell was derived from BeWo cell line (ATCC CCL-98) and were given different doses of ATRA. Results: From this study, Choriocarcinoma cell that was given ATRA in dosage of 50μg/ml inhibit telomerase activity by extending the cycle time of 39.51±0.09, compared to the control group with a cycle time of 37.62±0.43. Cycle length change consistently with higher dose of ATRA. Conclusion: This study has proven that ATRA could inhibit telomerase activity by lengthening the cycle. Changes in the increase of ATRA doses in this experimental test need to be studied further on experimental animals, either administered as a single agent or as an addition to standard treatment of trophoblastic disease

Coriocarcinoma no gestacional: reporte de un caso / No gestational choriocarcinoma: case report

Resumen ANTECEDENTES: El coriocarcinoma es una neoplasia maligna del epitelio trofoblástico, agresiva pero susceptible de curación, incluso cuando hay metástasis. Puede ser de origen gestacional o no, el primero aparece después de un embarazo molar o aborto. CASO CLÍNICO: Paciente de 14 años, acudió a Urgencias debido a un cuadro de abdomen agudo, con prueba en orina positiva de embarazo; además, una tumoración en la región anexial derecha. En la laparotomía se encontró una tumoración dependiente del anexo derecho, con la cápsula rota, adherida al colon. Un día después de la intervención quirúrgica (por no contar con recursos en la unidad) se tomó la fracción beta de gonadotropina coriónica. El diagnóstico definitivo se estableció con base en el reporte del estudio histopatológico de la pieza quirúrgica. CONCLUSIÓN: El coriocarcinoma es una neoplasia maligna del epitelio trofoblástico, muy agresiva pero susceptible de curación, incluso cuando se detectan metástasis. La incidencia en México de coriocarcinoma gestacional es de 0.133 por cada 100,000 mujeres, mientras que la incidencia del cariocarcinoma no gestacional se desconoce. Se reporta como un tumor muy raro; por ello el diagnóstico preciso y oportuno es difícil en este tipo de tumores; la presentación más habitual es el abdomen agudo.

Abstract BACKGROUND: Choriocarcinoma is a malignant neoplasm of the trophoblastic epithelium, very aggressive but highly curable, even when there is metastasis. It can be of gestational and non-gestational origin, the first one can develop after a pregnancy, abortion or molar pregnancy; in Mexico it is calculated with an incidence of 0.133 per 100,000 women. While the incidence of non-gestational choriocarcinoma is unknown as it is reported as a very rare tumor. The objective is present the first case reported in our hospital, there are few cases reported in Mexico, it is important to know them in order to identify, diagnose and refer them on time. CLINICAL CASE: A 14-year-old patient who presented to the emergency department with a picture of acute abdomen with pregnancy test in positive urine and tumor in the right adnexal region, laparotomy was performed, finding a tumor dependent on the right annex with a broken capsule attached to the colon, one day after the surgical event (due to lack of resources in the unit) beta fraction of chorionic gonadotropin, the definitive diagnosis was made by the histopathological study of the surgical piece. CONCLUSION: Choriocarcinoma is a malignant neoplasm of the trophoblastic epithelium, very aggressive but highly curable, even when metastases are detected. In Mexico, the incidence of gestational choriocarcinoma is 0.133 per 100,000 women, while the incidence of non-gestational cariocarcinoma is unknown, it is reported as a very rare tumor, which is why accurate and early diagnosis is difficult in this type of tumors. , since the most common presentation is an acute abdomen.