Otolaryngology Department, Royal Surrey Hospital, Guildford, Surrey, UK.
Histopathology Department, Royal Surrey Hospital, Guildford, Surrey, UK.
Head Neck Pathol. 2021 Sep;15(3):1047-1053. doi: 10.1007/s12105-020-01245-w. Epub 2020 Oct 31.
Extragonadal non-gestational choriocarcinoma is a rare but well-described phenomenon occurring in patients with midline germ cell tumors. Choriocarcinoma (ChC) is an aggressive neoplasm usually developing in women as a rare complication of pregnancy. In male patients ChC occurs in the testes, usually as a component of mixed germ cell tumors. Very few patients develop extragonadal choriocarcinoma with the tumor occurring in midline locations, such as the mediastinum, retroperitoneum, and central nervous system (mostly pineal gland). Non-midline choriocarcinoma can occur in the lung, gastrointestinal tract, and breast, sometimes blended with another primary malignancy. A midline choriocarcinoma manifesting as a head and neck malignancy is exceptional. During an evaluation of multiple enlarged cervical lymph nodes suspected to be lymphoma in a 72-year-old man, a core biopsy was taken from one of the left neck lymph nodes which histologically showed a necrotic malignancy with strong diffuse pancytokeratin staining. After an initial interpretation of metastatic carcinoma, further samples were taken from both tonsils and from a right level 5 neck lymph node. Histologically, all samples contained the same tumor, showing profound pleomorphism and multinucleated syncytial-type giant cells. A panel of immunohistochemistry studies were performed, including β-human chorionic gonadotropin, with positive findings leading to a diagnosis of extragonadal non-gestational choriocarcinoma.
生殖系统外非妊娠性绒毛膜癌是一种罕见但已有明确描述的现象，发生于中线生殖细胞肿瘤患者。绒毛膜癌（ChC）是一种侵袭性肿瘤，通常在女性中作为妊娠的罕见并发症发生。在男性患者中，ChC 发生于睾丸，通常作为混合生殖细胞肿瘤的一部分。极少数患者会发生生殖系统外绒毛膜癌，肿瘤发生于中线部位，如纵隔、腹膜后和中枢神经系统（主要是松果体）。非中线绒毛膜癌可发生于肺部、胃肠道和乳腺，有时与另一种原发性恶性肿瘤混合存在。表现为头颈部恶性肿瘤的中线绒毛膜癌非常罕见。在对一名 72 岁男性的多个增大的颈部淋巴结进行疑似淋巴瘤的评估时，从左侧颈部淋巴结的一个部位进行了核心活检，组织学显示为具有强烈弥漫性细胞角蛋白染色的坏死性恶性肿瘤。在最初解释为转移性癌后，从两个扁桃体和右侧 5 区颈部淋巴结中又采集了样本。组织学上，所有样本均包含相同的肿瘤，表现为明显的多形性和多核性合胞体样巨细胞。进行了一组免疫组织化学研究，包括β-人绒毛膜促性腺激素，阳性结果导致诊断为生殖系统外非妊娠性绒毛膜癌。
