대한흉부영상의학회 Weekly Chest Cases

Case No : 857 Date 2014-03-31

Courtesy of Kyung Won Doo / Korea University Guro Hospital
Age/Sex 38 / F
Chief ComplaintDyspnea

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Diagnosis With Brief Discussion

Diagnosis: Choriocarcinoma of the lung
Radiologic Findings: Chest CT shows multiple, variable sized, nonenhancing lobulated nodule or masses in both lungs with enhancing tubular structure in mass at LLL lateral basal segment.

CT guided biopsy was done in LLL, and choriocarcinoma was confirmed. Laboratory examination revealed elevated beta hCG level (73211mIU/ml) and on endometrial curettage, only secretory endometrium with stromal breakdown was noted.
During the hospitalization, she had hematochezia. On enteroscopy, ulcerofungating mass with active bleeding was noted at mid jejunum. Segmental resection of small bowel was perfomed and, metastatic choriocarcinoma was also diagnosed. On liver MRI, hypervascular hepatic metastases were noted.
Brief Review: Choriocarcinoma is rare malignant disorder of trophoblastic cells with producing hCG. It can arise after a pregnancy, as a component of germ cell tumors, or in association with a poorly differentiated somatic carcinoma. 3 % of patients with choriocarcinoma have lung metastases. Angiosarcomas and choriocarcinomas are most representative causes of hemorrhagic metastases.
Choriocarcinoma of the lung could represent metastases from unknown trophoblastic disease, which might undergo a spontaneous regression, sometimes leaving only the uterus. This 'burnt-out' phenomenon would be a unique and specific feature of choriocarcinoma that is likely to become metastatic before detection of the primary lesion. Although several cases of choriocarcinoma without a uterine lesion discovered by respiratory symptoms (cough, dyspnea, and bloody sputum) have been reported, multiple pulmonary nodules were observed in most cases.
References: 1. Ibi et al. Choriocarcinoma of the lung: report of a case. Gen Thorac Cardiovasc Surg 2012; 60:377-380.
2. Seo et al. Atypical Pulmonary Metastases: Spectrum of Radiologic Findings. RadioGraphics 2001;21:403-417.
Keywords: Lung, Malignant tumor,

No. of Applicants : 83

▶ Correct Answer : 8/83, 9.6%

- Tokyo Metropolitan Police Hospital , Japan Akifumi Hagiwara
- Niigata City General Hospital , Japan Takao Kiguchi
- Chonnam National University Hospital , Korea (South) Sungmin Moon
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- Seoul National University Hospital , Korea (South) Sang Min Lee
- Oita University , Japan Haruka Sato
- Medicheck health care , Korea (South) Chae Lim

▶ Correct Answer as Differential Diagnosis : 17/83, 20.5%

- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
- sahyadri speciality hospital , India kothareddy dileepreddy
- GHICL , France manuel toledano
- Chonnam National Univ. Hospital , Korea (South) Jaemyeong Jo
- McGill University Health Center , Canada Alexandre Semionov
- Chungbuk University Hospital , Korea (South) Yunhee Jang
- IRSA La Rochelle , France Denis Chabassiere
- Onomichi municipal hospital , Japan Hirofumi Mifune
- CMC , Korea (South) Soh Yong Jeong
- Mallinckrodt Institute of Radiology , United States Naganathan Mani
- Teikyo University Mizonokuchi Hospital , Japan Kaoru Sumida
- IRSA LA ROCHELLE , France, Metropolitan BIGOT
- TCM HOSPITAL OF ZIGONG , China Cao Cunyou
- Okayama University , Japan Toshiyuki Komaki
- The University of Tokyo Hospital , Japan Toshihiro Furuta
- Niigata University , Japan Atsushi Uehara

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 857 Date 2014-03-31

Discussion

No. of Applicants : 83