1/19. False diagnosis and needless therapy of presumed malignant disease in women with false-positive human chorionic gonadotropin concentrations.BACKGROUND: 12 women were diagnosed of having postgestational choriocarcinoma on the basis of persistently positive human chorionic gonadotropin (hCG) test results in the absence of pregnancy. Most of the women had extirpative surgery or chemotherapy, or both, without significant diminution in hCG titre. Our aim was to assess whether the hCG concentrations were false-positive test results. methods: Samples were tested for hCG, hCG free beta subunit, and hCG beta-core fragment. Assay kinetics were also assessed, and samples were tested independently by competitive RIA. False-positive hCG concentrations were identified by two criteria: detection of hCG in serum and lack of detection of hCG and its degradation products in urine; and wide variations in results for different hCG assays. We corroborated false-positive hCG values by the lack of parallel changes in hCG results when serum was diluted, by false detection of other antigens, and by failure to detect hCG with in-house assays. FINDINGS: All 12 women met both criteria for false-positive hCG, and all had corroborating findings. In all 12 cases, a false diagnosis had been made, and most of the women had been subjected to needless surgery or chemotherapy. Assay kinetics indicated that heterophilic antibodies were responsible for the false-positive results. As a result of our findings all further therapy was stopped. INTERPRETATION: Current protocols for the diagnosis and treatment of choriocarcinoma should be modified to include a compulsory test for hCG in urine.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/19. Primary hepatic choriocarcinoma--a case report.A 65-year-old man experienced anorexia and abdominal enlargement and died suddenly 45 days after admission. Multiple necrotic and hemorrhagic tumors were present in the liver (6 kg). The fragile tumor ruptured and a large amount of blood accumulated in the peritoneal cavity. The tumor was composed of cytotrophoblast and syncytiotrophoblast cells. Neoplastic cells were positive for human chorionic gonadotropin and negative for alpha-fetoprotein and carcinoembryonic antigen. The huge tumor directly invaded the entire antrum of stomach. Neoplastic trophoblastic cells proliferated mainly in the serosa and propria muscular layer of the stomach, and tiny cancer nests were observed in many vessels of the submucosa and propria mucosa. The serum alpha and beta human chorionic gonadotropin subunits showed a very high level; 51 ng/mL and 820 ng/mL, respectively. No tumor, cyst or scar was observed in the testes, mediastinum and retroperitoneum, macroscopically and microscopically. Based on these autopsy findings, we diagnosed this patient as having primary hepatic choriocarcinoma.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
3/19. Primary omental gestational choriocarcinoma ascertained by deoxyribonucleic acid polymorphism analysis.BACKGROUND: Abdominal choriocarcinoma is extremely rare. It is important to examine whether the disease is primary or metastatic and gestational or non-gestational. CASE: A 26-year-old nulli-gravid woman underwent laparoscopy for presumed ectopic pregnancy. The uterus, ovaries and fallopian tubes surrounded by hemoperitoneum were unremarkable. A hemorrhagic 7-cm-sized tumor was identified on the greater omentum and excised. histology was consistent with choriocarcinoma. Analysis of human leucocyte antigen (HLA) gene polymorphism on deoxyribonucleic acid (dna) demonstrated that tumor dna contained both HLA locus antigens of patient and of her husband. Clinical remission was achieved with six courses of chemotherapy. CONCLUSION: To our knowledge, this is the first reported case of choriocarcinoma that occurred primarily on the omentum ascertained to be of gestational origin by dna polymorphism analysis.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
4/19. Primary pulmonary choriocarcinoma combined with adenocarcinoma.An extremely rare autopsy case of primary pulmonary choriocarcinoma combined with adenocarcinomatous components in a 77-year-old Japanese man is described. The patient died of rapidly progressive respiratory dysfunction without ante-mortem diagnosis. autopsy revealed necro-hemorrhagic areas of the primary lung tumor with a typical biphasic pattern of choriocarcinoma. Topographical analysis suggested that moderately to poorly differentiated adenocarcinoma components partially surrounded the choriocarcinomatous components. Moreover, dedifferentiated carcinomatous components were scattered next to both adenocarcinomatous and choriocarcinomatous areas, and a few cells of the dedifferentiated carcinomatous components had a similar immunoreaction to conventional adenocarcinomatous or choriocarcinomatous components, such as surfactant apoprotein A, placental alkaline phosphatase or beta-human chorionic gonadotropin. Additionally, epithelial membrane antigen-positive cytotrophoblastic cells were rarely found in choriocarcinomatous areas. The present case suggests that primary lung choriocarcinoma can occur closely related to conventional pulmonary adenocarcinoma, although collision tumor was not completely ruled out.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
5/19. Genetic identification of pregnancies responsible for choriocarcinomas after multiple pregnancies by restriction fragment length polymorphism analysis.The pregnancies responsible for two cases of choriocarcinomas were determined by the restriction fragment length polymorphism of human leukocyte antigen-DQ genes in the tumors and leukocytes from the patients, their husbands, and their children. The first case was preceded by three normal pregnancies, and the second case was preceded by two normal pregnancies and a complete hydatidiform mole. Comparison of the restriction fragment length polymorphism patterns revealed that the first case of choriocarcinoma carried the parental genome and originated from the third normal pregnancy, whereas the second case was of androgenetic origin from the complete mole. By choosing an appropriate probe (or probes), restriction fragment length polymorphism analysis is shown to be a useful method for identification of the pregnancy responsible for choriocarcinoma.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
6/19. Enzyme histochemical, immuno histochemical and electron microscopic studies of two cases of leukemic malignant histiocytosis.Two cases of leukemic malignant histiocytosis had similar morphologic and enzyme histochemical findings. Large blasts with low nuclear/cytoplasmic ratios, occasional azurophilic granules, and immature nuclei with nucleoli were seen in peripheral blood and bone marrow smears. Case 1 had occasional erythrophagocytosis, while in Case 2 it was rare. They were peroxidase negative, and very strongly positive by alpha-naphthyl butyrate esterase stain, the latter being inhibited by sodium fluoride. acid phosphatase stains were also very strongly positive and were inhibited with tartaric acid. They were also stained granularly with PAS. Surface marker analysis revealed myeloid surface antigens, cd11 , CD13 and HLA-DR in Case 1, and CD11 , CD13 , CD33 and HLA-DR in Case 2. Immunoperoxidase stains of bone marrow biopsies revealed that lysozyme was positive in both cases. S-100 protein was strongly positive in Case 1, but weakly so in the skin tumor and negative in the bone marrow of Case 2. Electron microscopy showed both cases to be myeloperoxidase negative and rich in cytoplasmic organelles, such as lysosomes, mitochondria, and endoplasmic reticuli. Nuclei were irregularly shaped and nucleoli were present in virtually all the cells. These findings suggest that the malignant histiocytes in these two cases derive from bone marrow macrophages, and S-100 protein can also be detected in monocyte-macrophage derived histiocytes.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
7/19. An immunohistological study of HLA antigen expression by gestational choriocarcinoma.Two cases of gestational choriocarcinoma have been examined for the expression of HLA and trophoblast antigens using the indirect immunoperoxidase technique on frozen tissue sections. Approximately 40-70% of tumour cells express MHC Class I antigen as detected by a panel of antibodies to monomorphic, or framework, MHC Class I antigenic determinants. Evidence in one case suggests that most of these cells may not express the paternal, polymorphic HLA antigenic determinants but that a small subpopulation do carry the fully antigenically active molecule. These latter may give rise to patient anti-paternal HLA antibodies. Class II (HLA DR or DC) antigens are expressed by none, or very few, tumour cells.- - - - - - - - - - ranking = 10keywords = antigen (Clic here for more details about this article) |
8/19. Primary gastric choriocarcinoma. Report of an autopsy case with immunohistochemical study.An autopsy case of primary gastric choriocarcinoma of a 70-year-old Japanese female is presented. The tumor was initially diagnosed as poorly differentiated adenocarcinoma of the stomach by biopsy. autopsy revealed co-existence of choriocarcinoma and adenocarcinoma in the stomach and a large amount of human chorionic gonadotropin in the serum. The choriocarcinoma metastasized to the liver, lung, and omentum, and the adenocarcinoma to lymph nodes. In the gastric tumor, immunohistochemical stains showed human chorionic gonadotropin in choriocarcinoma cells, alpha-fetoprotein and carcinoembryonic antigen in adenocarcinoma cells. The pathogenesis and pathological characteristics of primary gastric choriocarcinoma are discussed.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
9/19. carcinoembryonic antigen staining in choriocarcinoma.choriocarcinoma of the colon presented as life-threatening lower gastrointestinal bleeding and a pathologic femoral fracture in a 42-year-old man. Elevated serum carcinoembryonic antigen (CEA) levels and immunohistochemical positivity for CEA in neoplastic syncytiotrophoblasts were noted, as well as the expected positivity for the beta subunit of human chorionic gonadotropin (beta HCG). Additional cases, including one of two gestational choriocarcinomas and one of four testicular choriocarcinomas studied immunocytochemically for CEA also demonstrated positivity. Although CEA staining is commonly associated with tumors derived from the surface epithelium of the gastrointestinal tract and other organs, its presence in choriocarcinomas should not be interpreted as conclusive evidence of primary origin from these sites.- - - - - - - - - - ranking = 5keywords = antigen (Clic here for more details about this article) |
10/19. Combined choriocarcinoma and adenocarcinoma of the lung.Combined choriocarcinoma and adenocarcinoma in the lung of a 71-year-old Japanese male is reported. In the upper lobe of the right lung (S1 2), a choriocarcinoma coexisted with an adenocarcinoma, but distinct metastatic lesions were noticed separately in the lungs, kidney, bone marrow and lymph nodes. Although immunohistochemical examination revealed intensely positive reactivity with anti-human chorionic gonadotropin (HCG) in trophoblastic cells, weak immunoreactivities were also observed in a few cells with anti-human placental lactogen (HPL), anti-pregnancy-specific beta glycoprotein (SPI), anti-epithelial membrane antigen (EMA), anti-carcinoembryonic antigen (CEA), anti-cytokeratin (keratin) and KM-93 (lung adenocarcinoma-associated antibody). In the adenocarcinoma, the tumor cells were positively stained for CEA, EMA, keratin and KM-93, but there were no positive reactivities for HCG, HPL and SPI. These findings suggest that primary choriocarcinoma of the lung may arise through dedifferentiation of adenocarcinoma.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
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