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1/10. Non-gestational choriocarcinoma in small intestine.

    choriocarcinoma most commonly arises from intrauterine gestational trophoblastic tissue; non gestational choriocarcinoma is rare. We report a 22-year-old married woman with non-gestational choriocarcinoma in the small intestine. Partial resection of the jejunum and ileum was done, followed by chemotherapy. She was well one year later. ( info)

2/10. Intratubular germ cell neoplasia of unclassified type occupying the whole testis accompanied by a small mature teratoma and metastatic choriocarcinoma and Sertoli cell-only tubules in the other testis.

    A 19-year-old man with mild mental retardation was diagnosed as having metastatic choriocarcinoma and a testicular tumor. Histopathological examination of the resected testis revealed the presence of a small lesion of mature teratoma but no trace of choriocarcinoma. The remaining seminiferous tubules were atrophic and lined by large atypical germ cells, which were diagnosed as intratubular germ cell neoplasia of the unclassified type (IGCNU). A small area with prominent tubules was also observed. Within this lesion, the tubules were dilated and contained several layers of cells with central necrosis. Immunohistological comparison of staining for several biological markers (Ki-67, c-kit and placental alkaline phosphatase) between cells in the atrophic tubules and those in the dilated tubules indicated a progression of the latter cells to cells with a more proliferative ability. In the opposite testis, examined at autopsy after death due to metastatic choriocarcinoma, all seminiferous tubules were lined by sertoli cells only. It was therefore assumed that the germ cell tumor of the combined histological type had primarily arisen in the background of IGCNU, and that choriocarcinoma had spontaneously regressed. The early onset of these testicular neoplastic lesions strongly indicates their occurrence under the genetic background of gonadal dysplasia, the sertoli cell-only syndrome. The possible relation of gonadal disease to mental retardation in this patient is also discussed. ( info)

3/10. Concurrent ovarian-type primary peritoneal adenocarcinoma and peritoneal choriocarcinoma. A case report and review of the literature.

    BACKGROUND: Nongestational choriocarcinomas are aggressive tumours occurring either as a global event or as a focal change in solid tumours. The latter is responsible for coexistence of trophoblastic histology with other malignancies. CASE: A 65-year old female with stage IV primary peritoneal carcinoma, ovarian type, underwent surgical cytoreduction followed by two courses of paclitaxel/carboplatin chemotherapy. A choriocarcinomatous component was later identified in the resection specimens, as chemotherapy resulted in a differential response of the two malignant variants. Commencement of EMA/CO chemotherapy (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) resulted in symptom palliation and tumour regression, further consolidated with platinum-based EP/EMA (etoposide, cisplatin, methotrexate, actinomycin D). Two months later, relentless choriocarcinomatous disease progression followed, leading to the patient's death while the peritoneal adenocarcinomatous variant remained biochemically quiescent. CONCLUSION: Choriocarcinomas may coexist with typical ovarian-type peritoneal cancer, creating diagnostic and therapeutic dilemmas. Aggressive weekly chorio-type chemotherapy appears to be warranted despite the low likelihood of cure, as it provides significant symptom palliation. ( info)

4/10. Pure nongestational choriocarcinoma of ovary.

    INTRODUCTION: Primary ovarian choriocarcinoma arising presumably from a germ cell is extremely rare. Besides arising gestationally or nongestationally, it may be pure or mixed with other germ cell tumors like immature teratoma, dysgerminoma, polyembryoma. CASE REPORT AND DISCUSSION: We present a case of a 22-year-old woman diagnosed with pure nongestational choriocarcinoma of the ovary with a review of the literature and discussion of its origin. ( info)

5/10. Extraovarian nongestational choriocarcinoma in a postmenopausal woman.

    Primary extrauterine choriocarcinoma especially in the postmenopausal period is very rare. A 69-year-old woman, complaining of back pain, weakness, and severe fatigue with gross hematuria, was found to have paraovarian pelvic mass and underwent laparotomy. At the operation, a mass located in the right adnexal region, extending to the retroperitoneum and within the normal pathway of germ cell migration, was observed. Other peritoneal surfaces, the uterus, both the ovaries, and fallopian tubes were normal. Total abdominal hysterectomy, bilateral salphingo-oophorectomy, and excision of the right adnexal mass were performed. The histopathological report showed an extrauterine, nongonadal pure choriocarcinoma. As single-agent chemotherapy with methotrexate was ineffective, the patient received multiagent chemotherapy and responded well to the treatment. After 18 months following chemotherapy, the patient was disease free. Extraovarian nongestational choriocarcinoma can be seen within the normal pathway of germ cell migration and responds to chemotherapy-like gestational choriocarcinoma. ( info)

6/10. Rectal adenocarcinoma with choriocarcinomatous differentiation: clinical and genetic aspects.

    Nongestational choriocarcinomas are rare tumors. In the gastrointestinal tract, they are characterized by a biphasic tumor growth with separated areas of adenocarcinomatous and choriocarcinomatous differentiation. We here report a case of a combined adenocarcinoma-choriocarcinoma of the rectum. The tumor showed an aggressive clinical behavior with metastasis to the liver and lungs. A transient partial remission was achieved after 4 cycles of cisplatinum, etoposide, and ifosfamide chemotherapy, with normalization of serum beta-human chorionic gonadotropin levels. At this time, viable residual choriocarcinoma cells were found in surgically resected lung metastasis. The patient succumbed 8 months after initial diagnosis to a rapid abdominal relapse. We used comparative genomic hybridization (CGH) and fluorescence in situ hybridization to elucidate the genetic relationship of adenocarcinoma and choriocarcinoma in this neoplasm. We found genetic changes characteristic for colorectal adenocarcinomas, a loss of chromosomal regions 8p21-pter as well as 18q21-pter, and a gain of 5p and 20q, in both tumor parts. This provides evidence for the common origin of both components. A differential pattern of additional genetic changes suggests a clonal evolution from a common ancestor cell. In contrast to findings from a comparative study on a choriocarcinoma of the renal pelvis, we did not find an amplification of the germ cell cancer-associated chromosomal region 12p11.2-p12.1 in the areas of choriocarcinoma but found instead a loss of Xp11.3-pter. To our knowledge, this is the first report of a CGH comparison of the adenocarcinomatous and choriocarcinomatous tumor parts in a nongestational choriocarcinoma of the gastrointestinal tract. ( info)

7/10. Primary non-gestational choriocarcinoma of the uterine cervix: a case report.

    BACKGROUND: Primary non-gestational choriocarcinoma of the female genital tract has been described in the ovaries and is very unusual in other genital sites. CASE: Primary non-gestational uterine cervical choriocarcinoma was diagnosed in a patient, 32, single, without previous sexual contact nor antecedent pregnancy, admitted to the hospital with irregular vaginal hemorrhaging. Pelvic examination realized under anesthetic revealed a tumor mass occupying the uterine cervix. Metastases investigation was realized and the patient was accepted as FIGO IV: risk factor of 13. She was submitted to intensive chemotherapy and hysterectomy, showing general recovery, but died from drug-resistant disease 12 months later. Histological, immunohistochemical, and molecular genetics studies confirmed non-gestational choriocarcinoma. CONCLUSION: Primary non-gestational uterine cervical choriocarcinoma may arise from germ cell tumor or epithelial tissue. ( info)

8/10. Postmenopausal choriocarcinoma: a case report.

    Postmenopausal uterine choriocarcinoma is very rare and benefits of curative chemotherapy. We present here the case of 62-year-old women with uterine bleeding. Emergency surgery revealed a uterine tumor and histopathology findings were consistent with choriocarcinoma. immunohistochemistry tests confirmed betahCG and cytokeratin expression by malignant cells, thus establishing the positive diagnosis. ( info)

9/10. Primary pulmonary choriocarcinoma--a series of 7 cases.

    Primary pulmonary choriocarcinoma is a rare manifestation of extra-genital malignant germ cell tumour. This is a report of seven such cases, seen in autopsy and surgical materials in a span of 20 years. The age range was from 25 to 60 years, affecting six women and one male. These are aggressive tumours requiring prompt therapy. Only one among the seven survived. ( info)

10/10. Pure non-gestational choriocarcinoma of the ovary diagnosed by dna polymorphism analysis.

    Pure primary ovarian choriocarcinoma is a rare condition that can be of gestational or non-gestational origin. Non-gestational choriocarcinoma has been found to be resistant to single-agent chemotherapy and has a worse prognosis than gestational choriocarcinoma, but it is difficult to distinguish the two types by routine histological examination. Herein is reported a case of primary pure non-gestational choriocarcinoma of the ovary in a 33-year-old nulligravid woman, as confirmed by dna polymorphism analysis. All tested microsatellite markers had identical dna profiles with the same allelic sizes between the tumor and the myometrium of the patient, who was homozygous for three markers (BAT26, BAT25 and D17S250) and heterozygous for four (D2S123, D18S57, DCC and D18S58), supporting non-gestational origin. The patient has no evidence of disease 17 months after surgery and four cycles of combination chemotherapy. This case demonstrates the usefulness of dna polymorphism analysis for the determination of the origin of extrauterine choriocarcinoma. Clinical relevance of this method needs to be further studied and substantiated. ( info)
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