Pan Weiyu, Hou Jun
Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China.
Transl Cancer Res. 2022 Sep;11(9):3416-3420. doi: 10.21037/tcr-22-766.
Primary mediastinal choriocarcinoma is an extremely rare malignant tumor, that is prone to early metastasis and often misdiagnosed. Currently, there is no standardized treatment for primary mediastinal choriocarcinoma. Herein, we report a case to share our experience in the diagnosis and treatment of primary mediastinal choriocarcinoma.
A 19-year-old male patient who presented with chest pain and occasional cough for 1 month. He was diagnosed as mediastinal tumor with multiple lung metastases by imaging modalities in a local hospital, and therapeutic surgical excision was performed for the metastasis lesions in lower lobe of right lung. The pathological examination of the surgical specimens supported lung metastasis of choriocarcinoma. Then he was transferred to our hospital for further treatment. Elevated β-human chorionic gonadotropin (β-hCG) serum levels (>200,000 mIU/mL, normal <5 mIU/mL) combined with imaging modalities and pathological consultation of the surgical specimens at admission in our hospital supported the diagnosis of primary mediastinal choriocarcinoma with multiple metastases. During the treatment, we used a variety of treatments, including chemotherapy, radiotherapy and Pembrolizumab. After one cycle of EP chemotherapy (etoposide and cisplatin), computed tomography (CT) scan showed that new nodules appeared in the liver, mass in the anterior mediastinum and part of the nodules in the lungs were enlarged. Pembrolizumab was initiated because of the tumor cells were positive for programmed cell death 1 ligand 1 (PD-L1). The mediastinal mass shrank after two cycles of Pembrolizumab. However, due to the rapid progress of the disease, the patient died of the disease 4 months after the initial symptoms.
Advanced primary mediastinal choriocarcinoma is highly aggressive and insensitive to chemotherapy. Pembrolizumab may be used as a salvage treatment for primary mediastinal choriocarcinoma.
原发性纵隔绒毛膜癌是一种极其罕见的恶性肿瘤，易于早期转移且常被误诊。目前，原发性纵隔绒毛膜癌尚无标准化治疗方案。在此，我们报告一例病例，分享我们在原发性纵隔绒毛膜癌诊断和治疗方面的经验。
一名19岁男性患者，出现胸痛和偶尔咳嗽1个月。在当地医院通过影像学检查被诊断为纵隔肿瘤伴多发肺转移，对右肺下叶转移灶进行了治疗性手术切除。手术标本的病理检查支持绒毛膜癌肺转移。随后他被转至我院进一步治疗。入院时血清β-人绒毛膜促性腺激素（β-hCG）水平升高（>200,000 mIU/mL，正常<5 mIU/mL），结合影像学检查及手术标本的病理会诊，支持原发性纵隔绒毛膜癌伴多发转移的诊断。治疗期间，我们采用了多种治疗方法，包括化疗、放疗和帕博利珠单抗。在进行一个周期的EP化疗（依托泊苷和顺铂）后，计算机断层扫描（CT）显示肝脏出现新结节，前纵隔肿块及部分肺部结节增大。由于肿瘤细胞程序性死亡受体1配体1（PD-L1）呈阳性，开始使用帕博利珠单抗。经过两个周期的帕博利珠单抗治疗后，纵隔肿块缩小。然而，由于疾病进展迅速，患者在出现初始症状4个月后死于该病。
晚期原发性纵隔绒毛膜癌具有高度侵袭性且对化疗不敏感。帕博利珠单抗可作为原发性纵隔绒毛膜癌的挽救治疗药物。
