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Primary Choriocarcinoma In The Posterior Mediastinum
0022-5347/02/1674-1789/0 THE JOURNAL OF UROLOGY® Copyright © 2002 by AMERICAN UROLOGICAL ASSOCIATION, INC.®
Vol. 167, 1789, April 2002 Printed in U.S.A.
PRIMARY CHORIOCARCINOMA IN THE POSTERIOR MEDIASTINUM SIN-ICHI YAMASHITA, CHIKARA OHYAMA, HARUO NAKAGAWA, AKIRA TAKEUCHI, MIKA WATANABE AND SENJI HOSHI From the Departments of Urology and Pathology, Tohoku University of Medicine, Sendai, Japan KEY WORDS: choriocarcinoma, mediastinal neoplasms, germinoma
Primary extragonadal germ cell tumors in the mediastinum are rare, and most of these neoplasms occur in the anterior mediastinum. To our knowledge we report the first case of primary choriocarcinoma in the posterior mediastinum. CASE REPORT
A 29-year-old man complaining of headache and vomiting underwent surgical resection of a cerebellar tumor elsewhere. The tumor was pathologically diagnosed as choriocarcinoma. The patient was referred to our hospital with a diagnosis of extragonadal germ cell tumor. At the time of hospitalization the testes were clinically normal. Human chorionic gonadotropin (HCG) was elevated at 9,344 mIU/ml. (normal less than 3.0), -HCG was 152 ng./ml. (normal less than 0.1) and ␣-fetoprotein was within normal limits. Multiple pulmonary lesions were demonstrated on chest x-ray. Computerized tomography (CT) also showed multiple pulmonary lesions and a 9 cm. mass in the right upper and posterior mediastinum (fig. 1). CT did not reveal any lesions in the retroperitoneum, and the testes were normal on magnetic resonance imaging and ultrasound. The patient received 2 cycles of combination (cisplatin plus etoposide) chemotherapy. On the third day of the first cycle hemoptysis developed, necessitating cancellation of chemotherapy on days 4 and 5. When the patient’s general condition improved to some degree the second cycle was administrated. After treatment HCG decreased to 405 mIU/ml. and -HCG decreased to 31 ng./ml. However, after the second cycle disseminated intravascular coagulation and the acute respiratory distress syndrome developed, and the patient died approximately 3 months after the onset of illness. Autopsy revealed that the primary tumor was located in the posterior mediastinum and was compressing the lung anteriorly (fig. 2). Lung tissue not involved by the tumor Accepted for publication November 16, 2001.
FIG. 2. Primary tumor, pathologically choriocarcinoma, is located on posterior mediastinum compressing lung anteriorly.
showed diffuse alveolar damage. Pathological diagnosis was primary posterior mediastinal choriocarcinoma with multiple metastases to the lung, liver, brain, pancreas and kidney. DISCUSSION
Primary extragonadal germ cell tumors are rare, accounting for only 1% to 5% of all germ cell neoplasms.1 These tumors most commonly occur in the retroperitoneum or the mediastinum, but rarely occur in the pineal gland or presacral area.2 Primary mediastinal germ cell tumors usually appear in the anterior mediastinum. Makiyama and Senga reported on a 69-year-old man with a primary seminoma of the posterior mediastinum.3 To our knowledge, however, primary choriocarcinoma in the posterior mediastinum has not been reported previously. It is well known that choriocarcinoma grows rapidly and metastasis occurs easily. The prognosis for patients with choriocarcinoma is generally poor. On the other hand, there are some reports of long-term survival. Thus, extragonadal germ cell tumors should be immediately treated with cisplatin containing combination chemotherapy. In particular, cases with numerous metastases to the lung should be treated to prevent pulmonary complications, including bleeding from the lung and the acute respiratory distress syndrome. REFERENCES
FIG. 1. CT shows 9 cm. mass in right upper and posterior mediastinum.
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1. Hainsworth, J. D. and Greco, F. A.: Extragonadal germ cell tumors and unrecognized germ cell tumors. Semin Oncol, 19: 119, 1992 2. Johnson, D. E., Laneri, J. P., Mountain, C. F. et al: Extragonadal germ cell tumors. Surgery, 73: 85, 1973 3. Makiyama, K. and Senga, Y.: Primary seminoma in the posterior mediastinum. J Urol, 165: 908, 2001
Vol. 167, 1789, April 2002 Printed in U.S.A.
PRIMARY CHORIOCARCINOMA IN THE POSTERIOR MEDIASTINUM SIN-ICHI YAMASHITA, CHIKARA OHYAMA, HARUO NAKAGAWA, AKIRA TAKEUCHI, MIKA WATANABE AND SENJI HOSHI From the Departments of Urology and Pathology, Tohoku University of Medicine, Sendai, Japan KEY WORDS: choriocarcinoma, mediastinal neoplasms, germinoma
Primary extragonadal germ cell tumors in the mediastinum are rare, and most of these neoplasms occur in the anterior mediastinum. To our knowledge we report the first case of primary choriocarcinoma in the posterior mediastinum. CASE REPORT
A 29-year-old man complaining of headache and vomiting underwent surgical resection of a cerebellar tumor elsewhere. The tumor was pathologically diagnosed as choriocarcinoma. The patient was referred to our hospital with a diagnosis of extragonadal germ cell tumor. At the time of hospitalization the testes were clinically normal. Human chorionic gonadotropin (HCG) was elevated at 9,344 mIU/ml. (normal less than 3.0), -HCG was 152 ng./ml. (normal less than 0.1) and ␣-fetoprotein was within normal limits. Multiple pulmonary lesions were demonstrated on chest x-ray. Computerized tomography (CT) also showed multiple pulmonary lesions and a 9 cm. mass in the right upper and posterior mediastinum (fig. 1). CT did not reveal any lesions in the retroperitoneum, and the testes were normal on magnetic resonance imaging and ultrasound. The patient received 2 cycles of combination (cisplatin plus etoposide) chemotherapy. On the third day of the first cycle hemoptysis developed, necessitating cancellation of chemotherapy on days 4 and 5. When the patient’s general condition improved to some degree the second cycle was administrated. After treatment HCG decreased to 405 mIU/ml. and -HCG decreased to 31 ng./ml. However, after the second cycle disseminated intravascular coagulation and the acute respiratory distress syndrome developed, and the patient died approximately 3 months after the onset of illness. Autopsy revealed that the primary tumor was located in the posterior mediastinum and was compressing the lung anteriorly (fig. 2). Lung tissue not involved by the tumor Accepted for publication November 16, 2001.
FIG. 2. Primary tumor, pathologically choriocarcinoma, is located on posterior mediastinum compressing lung anteriorly.
showed diffuse alveolar damage. Pathological diagnosis was primary posterior mediastinal choriocarcinoma with multiple metastases to the lung, liver, brain, pancreas and kidney. DISCUSSION
Primary extragonadal germ cell tumors are rare, accounting for only 1% to 5% of all germ cell neoplasms.1 These tumors most commonly occur in the retroperitoneum or the mediastinum, but rarely occur in the pineal gland or presacral area.2 Primary mediastinal germ cell tumors usually appear in the anterior mediastinum. Makiyama and Senga reported on a 69-year-old man with a primary seminoma of the posterior mediastinum.3 To our knowledge, however, primary choriocarcinoma in the posterior mediastinum has not been reported previously. It is well known that choriocarcinoma grows rapidly and metastasis occurs easily. The prognosis for patients with choriocarcinoma is generally poor. On the other hand, there are some reports of long-term survival. Thus, extragonadal germ cell tumors should be immediately treated with cisplatin containing combination chemotherapy. In particular, cases with numerous metastases to the lung should be treated to prevent pulmonary complications, including bleeding from the lung and the acute respiratory distress syndrome. REFERENCES
FIG. 1. CT shows 9 cm. mass in right upper and posterior mediastinum.
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1. Hainsworth, J. D. and Greco, F. A.: Extragonadal germ cell tumors and unrecognized germ cell tumors. Semin Oncol, 19: 119, 1992 2. Johnson, D. E., Laneri, J. P., Mountain, C. F. et al: Extragonadal germ cell tumors. Surgery, 73: 85, 1973 3. Makiyama, K. and Senga, Y.: Primary seminoma in the posterior mediastinum. J Urol, 165: 908, 2001