Kaushik Himanshi, Deshmukh Mahesh, Gupte Smita, Kanchankar Niraj, Dongre Amol
Oncology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.
Histopathology, Alexis Multispeciality Hospital, Nagpur, IND.
Cureus. 2024 Jun 29;16(6):e63466. doi: 10.7759/cureus.63466. eCollection 2024 Jun.
Primary choriocarcinoma originating in the lung is a rare entity. These are highly malignant intrapulmonary tumors with a notoriously poor prognosis. The pathogenesis is unclear. A 34-year-old lady, with a history of abortion six months back, presented with left-sided chest pain for one month, dyspnea on exertion, weight loss, and loss of appetite. Computed tomography (CT) of the thorax was suggestive of a mass lesion 4 x 5 cm at the left upper lobe, which was invading the chest wall, and pleural effusion, histopathologically defined as adenocarcinoma. A positron emission tomography-computed tomography (PET-CT) scan showed a fluorodeoxyglucose (FDG) avid lesion in the left upper lobe of size 4 x 5 with invasion to the chest wall with no evidence of distant metastases. Urine pregnancy test (UPT) was negative for this patient. Thus, the patient was initially diagnosed with stage cT3N0M0 adenocarcinoma of left lung cancer. The sample was sent for the lung next-generation sequencing (NGS) panel. Meanwhile, the patient was empirically started on gefitinib. Tumor markers revealed raised beta-human chorionic gonadotropin (β-hCG) to 1,79,000 IU/ml. A review biopsy was done, which was suggestive of choriocarcinoma. Genetic testing of lung biopsy suggestive of XX chromosome, confirming the diagnosis of primary pulmonary choriocarcinoma (PPC). The patient was planned for chemotherapy with etoposide and cisplatin. The patient underwent embolization of the left internal mammary artery (IMA) and branches of the left subclavian vein. There was a gradual fall in β-hCG after the second dose of chemotherapy on day 7. For the diagnosis of PPC, immunohistochemistry (IHC) staining, β-hCG measurement, and examination to exclude primary gonadal malignancies are essential. A combination of surgery and chemotherapy is a favorable treatment. As it's a highly vascular tumor, selective arterial embolization can be life-saving in case of bleeding.
原发性肺绒毛膜癌是一种罕见的疾病。这些是高度恶性的肺内肿瘤，预后极差。其发病机制尚不清楚。一名34岁女性，6个月前有流产史，出现左侧胸痛1个月，活动后呼吸困难、体重减轻和食欲不振。胸部计算机断层扫描（CT）提示左肺上叶有一个4×5厘米的肿块，侵犯胸壁，伴有胸腔积液，组织病理学诊断为腺癌。正电子发射断层扫描-计算机断层扫描（PET-CT）显示左肺上叶有一个4×5大小的氟脱氧葡萄糖（FDG）摄取活跃的病灶，侵犯胸壁，无远处转移证据。该患者尿妊娠试验（UPT）为阴性。因此，患者最初被诊断为左肺癌cT3N0M0期腺癌。样本被送去进行肺癌下一代测序（NGS）检测。同时，患者经验性地开始使用吉非替尼治疗。肿瘤标志物显示β-人绒毛膜促性腺激素（β-hCG）升高至179000IU/ml。进行了复查活检，提示为绒毛膜癌。肺活检的基因检测提示为XX染色体，确诊为原发性肺绒毛膜癌（PPC）。患者计划接受依托泊苷和顺铂化疗。患者接受了左乳内动脉（IMA）和左锁骨下静脉分支的栓塞治疗。在第7天第二次化疗后，β-hCG逐渐下降。对于PPC的诊断，免疫组织化学（IHC）染色、β-hCG测量以及排除原发性性腺恶性肿瘤的检查至关重要。手术和化疗相结合是一种有效的治疗方法。由于它是一种血管丰富的肿瘤，在出血情况下选择性动脉栓塞可能挽救生命。
