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Weekly Chest CasesArchive of Old Cases

Case No : 1343 Date 2023-07-17

  • Courtesy of Woojin Lee, Seung-Jin Yoo, Yo Won Choi, Sang Hyun Paik / Hanyang University Medical Center
  • Age/Sex 24 / M
  • Chief ComplaintAcute left chest pain
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Choriocarcinoma (with extensive necrosis and hemorrhage)
Radiologic Findings
Fig 1. Chest PA shows multiple nodular opacities in both lungs with a large amount of left pleural effusion. A mediastinal mass was also suspected.

Fig 2-5. CT scan reveals a 9.4cm necrotic mass at the anterior mediastinum with heterogeneous enhancing areas. Multiple necrotic pulmonary metastases were seen in both lungs, less than 3.5cm in size.
A large amount of left pleural effusion was also noted, resulting in passive atelectasis of left lung.
His alpha-fetoprotein level was 1.4 ng/mL (reference: 1.1–5.0 ng/mL). His beta-hCG level was 10803.0 mIU/mL (reference: 0–2.6 mIU/mL).
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.
Trophoblastic tumors such as choriocarcinoma display three major characteristics of trophoblastic tissue: the tendency to invade blood vessels, rapid proliferation, and rich vascularity. These features account for the hemorrhagic event of metastatic choriocarcinoma such as hemoptysis and hemothorax.
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
3. Ibi et al. Choriocarcinoma of the lung: report of a case. Gen Thorac Cardiovasc Surg 2012; 60:377-380.
4. Saha K, Basuthakur S, Jash D, Bandyopadhyay A. Gestational choriocarcinoma presenting as hemothorax. Indian J Med Sci 2010;64:237-40.
Keywords

No. of Applicants : 85

▶ Correct Answer : 33/85,  38.8%
  • - , Japan SUZUNE TSUKAMOTO
  • - The University of Tokyo Hospital , Japan JUN KANZAWA
  • - , Japan KYOKO NAGAI
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Chonnam National University Hospital , Korea (South) CHAEWON SONG
  • - Chonnam National University Hospital , Korea (South) HYUNJIN KIM
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Other , Korea (South) SEONGSU KANG
  • - , China FANG YING GEN
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Osaka University , Japan AKINORI HATA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Korea (South) HEONSEOK LEE
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - Korea University Guro Hospital , Korea (South) LEE DAKYONG
  • - Chonnam National University Hospital , Korea (South) GYERYEONG PARK
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Kyoto University , Japan SHO KOYASU
  • - Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - , Japan YUMI MAEHARA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - Kyoto university , Japan AKIHIKO SAKATA
  • - , Korea (South) JIN WOO YOON
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 9/85,  10.6%
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Yonsei University,Yongin Severance Hospital , Korea (South) YESEUL KANG
  • - Hukuda memorial hospital , Japan SHINTARO KANO
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Asan Medical Center , Korea (South) BYUNGSOO KIM
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
▶ Semi-Correct Answer : 19/85,  22.4%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Yonsei University College of Medicine , Korea (South) INSUNG CHO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - The University of Tokyo Hospital , Japan WATARU GONOI
  • - OITA UNIVERSITY , Japan FUMIKA ISHITOBI
  • - , Japan YUKIKO USUI
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Seoul National University Hospital , Korea (South) SUNGHO HONG
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Other , Korea (South) HYE SUN RYU
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Chonnam Hospital , Korea (South) JAEHYUN PARK
  • - Shiga University of Medical Science , Japan RYO UEMURA
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Juntendo University , Japan YUTAKA IKENOUCHI
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