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Weekly Chest CasesArchive of Old Cases

Case No : 1027 Date 2017-07-03

  • Courtesy of Chul Hwan Park and Tae Hoon Kim / Gangnam Severance Hospital, Yonsei University College of Medicine
  • Age/Sex 24 / M
  • Chief ComplaintBlood tinged sputum for 5 days
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Primary mediastinal choriocarcinoma
Radiologic Findings
A 27-year-old male patient presented with hemoptysis for 5 days. Chest CT image with mediastinal setting showed about 5 x 3 cm irregular shape necrotic mass in the anterior mediastinum. Chest CT images with lung window setting showed multiple nodules with surrounding ground glass opacities in both lungs. F-18 FDG PET/CT images show about 5 cm hypermetabolic mass with internal necrosis in anterior mediastinum, and multiple hypermetabolic nodules in both lung fields. Testicular ultrasonography showed no mass lesion. His alpha-fetoprotein level was 2.3 ng/mL (reference: 1.1–5.0 ng/mL). His beta-hCG level was 9164.0 mIU/mL (reference: 0–2.6 mIU/mL). Wedge resection was performed from the left upper lobe. The pleural surface of the specimen was smooth and glistening. On multiple cut sections, multiple solid, tan nodules were found. Pathological diagnosis revealed choriocarcinoma (figure).
Brief Review
Choriocarcinoma is a highly malignant tumor that originates from syncytiotrophoblasts. Primary choriocarcinoma of the mediastinum is defined as a choriocarcinoma in the mediastinum without a primary gonadal lesion or metastatic retroperitoneal lymph nodes. Primary choriocarcinoma of the mediastinum is extremely rare, and the diagnosis of the primary choriocarcinoma is challenging. Patients with primary choriocarcinoma are usually young men between 20 and 30 years of age. The main symptoms of primary mediastinal choriocarcinoma include dry cough, hemoptysis, gynecomastia, and chest pain. Chest computed tomography shows a large irregular shaped mass with central necrosis, hemorrhage, or cyst formation in the anterior mediastinum. Early hematogenous metastases to the lung, liver, and brain are common. Serological examination demonstrates a high beta-hCG level. The prognosis of primary mediastinal choriocarcinoma is poor even after combination chemotherapy.
References
1. Gaude GS, Patil P, Malur PR, Kangale R, Dhorigol V, Anurshetru S, Karanji J (2013) Primary mediastinal choriocarcinoma. South Asian J Cancer 2:79
2. Zhang S, Gao H, Wang XA, Liang B, Li DW, Shao Y, Jiang SJ (2014) Primary choriocarcinoma in mediastinum with multiple lung metastases in a male patient: A case report and a review of the literature. Thorac Cancer 5:463-467
Keywords
Mediastinum, Hemorrahgic Metastasis from Choriocarcinoma, Primary Mediastinal Choriocarcinoma,

No. of Applicants : 99

▶ Correct Answer : 32/99,  32.3%
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Korea University Guro Hospital , Korea (South) SEIYOUNG LEE
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - , Korea (South) HANKYUL KIM
  • - Korea University Guro Hospital , Korea (South) GAYOUNG CHOI
  • - Seoul National University Hospital , Korea (South) JAE WON CHOI
  • - consultant radiologist , India DEVINDERPAL SINGH DHANOTA
  • - Other , Korea (South) SEONG SU KANG
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Amagasaki General Medical Center , Japan GENKI FUKUMOTO
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Asan Medical Center , Korea (South) JOOAE CHOE
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - Chonbuk National University Hospital , Korea (South) WON HYEONG IM
  • - Other , Korea (South) HAYEON LEE
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Kyeongpook National University Hospital , Korea (South) SUNGJUN MOON
  • - Multimagem Diagn泥˜sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - null , India rikhy krishnan
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Korea University Guro Hospital , Korea (South) SUN HONG
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Korea University Anam Hospital , Korea (South) DONGKYU LEE
  • - University of Utah , United States AKIHIKO SAKATA
  • - Korea University Guro Hospital , Korea (South) Yoonmi Choi
▶ Correct Answer as Differential Diagnosis : 7/99,  7.1%
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - 罹…stanbul , Turkey AYHAN YILMAZ
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Asan Medical Center , Korea (South) HONG SANG HYUP
  • - Gifu University Hospital , Japan Yo Kaneko
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Korea University Guro Hospital , Korea (South) HWANSEOK YONG
▶ Semi-Correct Answer : 20/99,  20.2%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Hospital Federico Abete , Argentina HO KYU LEE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Gifu University Hospital , Japan TOMOHIRO ANDO
  • - McGill University Health Center , Canada Alexandre Semionov
  • - NIMS, HYDERABAD , India BHASKAR K
  • - , Poland Bartosz Zabicki
  • - COLUMBIAASIA HOSPITAL , India MANJUNATH KATAVEERANAHALLY SHEKAR
  • - Hallym University Dongtan Medical Center , Korea (South) EUNJIN HWANG
  • - HHS , Canada S LEE
  • - Other , Korea (South) SUNG HYUN YOON
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - GHICL , France MANUEL TOLEDANO
  • - University of New South Wales , Australia RASHID HASHMI
  • - Other , Korea (South) DONGHWAN KIM
  • - Private sector , Greece VASILIOS TZILAS
  • - , China WANGJIAN ZHA
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