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Objectives Choriocarcinoma after a term pregnancy is rare and can be life-threatening, especially when it perforates the uterus, resulting in massive haemoperitoneum. As uterine rupture due to choriocarcinoma is uncommonly encountered in the clinical practice, its diagnosis is often missed or delayed. Case presentation We present a case of a 41-year-old para 4 + 1 who had acute abdomen and hypovolaemic shock secondary to haemoperitoneum at three months postpartum period. The urine pregnancy test was positive, and, therefore, a provisional diagnosis of a ruptured ectopic pregnancy was made. She was managed aggressively with fluids and blood product transfusion at the emergency department to achieve haemodynamic stability. Subsequently, she underwent an emergency laparotomy where intraoperatively noted a perforation at the left posterior uterine cornu with purplish tissue spillage. A wedge resection was performed, and the histopathological examination (HPE) was reported as atypical trophoblastic cells, in which choriocarcinoma could not be ruled out. The patient then underwent a total abdominal hysterectomy three weeks later. The final HPE confirmed the diagnosis of choriocarcinoma. Conclusions The clinical presentation of postpartum choriocarcinoma can be indistinguishable from a ruptured ectopic pregnancy. A high index of suspicion is crucial to allow early diagnosis.

Gestational choriocarcinoma is a malignant trophoblastic tumor arising from any gestational event, even with a long latency period, generally in the reproductive female. It is associated with a high level of beta-human chorionic gonadotropin. Its primary site is usually the uterus but not all patients have a detectable lesion in this site. Regression of the primary tumor after it has metastasized is not uncommon, and one-third of cases manifest as complications of metastatic disease. In this report we present an uncommon case of gestational choriocarcinoma with lung, liver and jejunal metastases at the time of diagnosis without evidence of pelvic disease, in 34-year-old woman. The main points of interest of our case were the development of the ovarian hyperstimulation syndrome with massive multicystic ovarian enlargement induced by high level of beta-human chorionic gonadotropin and the bleeding of jejunal and liver metastases, due to the high vascularity of the tumor tissue, a condition known as “Choriocarcinoma Syndrome”. We will focus on the radiological findings of metastases, bleeding complications and ovarian hyperstimulation syndrome.

Choriocarcinoma (CC) is a very rare and aggressive neoplasm. The characteristic feature of this disease is a rapid hematogenous spread, mainly to the lungs and brain, which largely defines clinical signs of the disease and complicates the diagnosis. Gastrointestinal metastases are rare, and of those, only few cases with gastric location have been reported. There are publications describing choriocarcinoma syndrome (CCS). As a rule, it presents in patients with an advanced disease and is characterized by hemorrhage from metastatic foci, leading to hemoptysis and gastrointestinal bleeding. CCS development is associated with poor prognosis and high mortality. This article describes a case of testicular CC with rare few gastric metastases, complicated by CCS.

Objective We present a case of choriocarcinoma in a viable pregnancy with the rare presentation of intractable lower back pain. Case report The patient is a 34-year-old multiparous woman with her second pregnancy, and a history of scoliosis with spinal fixation. Her first pregnancy was uneventful, with a term vaginal delivery. She was hospitalized four times due to intractable back pain from 25 to 31 weeks, and terminated at 31 weeks. The placenta was unremarkable on gross examination. Postpartum, the patient developed obstructive ileus, requiring a rectosigmoid resection. She was diagnosed with metastatic choriocarcinoma to the liver, para-aortic lymph nodes, and mesentery. A week later, she developed micro-thrombosis of all limbs, massive ascites, pleural effusion. Patient refused chemotherapy and died on post-operative Day 15. Conclusion Presentation of choriocarcinoma in pregnancy varies widely. Clinicians should consider the differential diagnosis of choriocarcinoma when faced with abnormal unexplained symptoms during pregnancy.

Summary Background Treatment options for patients with high-risk chemorefractory or relapsed gestational trophoblastic neoplasia are scarce. The synergistic antitumour effect of immunotherapy and antiangiogenic drugs has been shown in many solid tumours. This phase 2 trial evaluated the activity and safety of camrelizumab (PD-1 inhibitor) plus apatinib (VEGF receptor inhibitor) in patients with high-risk chemorefractory or relapsed gestational trophoblastic neoplasia. Methods This was a single-arm, open-label, phase 2 trial, done at a single tertiary health-care centre in Beijing, China. Women (18–70 years) with high-risk (International Federation of Gynecology and Obstetrics score ≥7) chemorefractory or relapsed gestational trophoblastic neoplasia who had received at least two lines of previously unsuccessful multidrug chemotherapy regimens and had an Eastern Cooperative Oncology Group performance status of 0–2 were eligible for inclusion. Patients received 4-week cycles of intravenous camrelizumab 200 mg every 2 weeks plus oral apatinib 250 mg once per day until disease progression or unacceptable toxicity. The primary endpoint was objective response rate assessed according to serum human chorionic gonadotrophin concentration. Activity and safety were analysed in all patients who received at least one dose of study drug. The study is ongoing, but recruitment is complete. The study is registered with ClinicalTrials.gov , NCT04047017 . Findings Between Aug 7, 2019, and March 18, 2020, 20 patients enrolled; 19 (95%) were diagnosed with choriocarcinoma and one (5%) had placental site trophoblastic tumour. The median follow-up duration was 18·5 months (IQR 14·6–20·9). The objective response rate was 55% (95% CI 32–77); ten (50%; 95% CI 27–73) patients had complete response. The most common grade 3 treatment-related adverse events were hypertension (five [25%] patients), rash (four [20%] patients), neutropenia (two [10%]), leukocytopenia (two [10%]), and aspartate aminotransferase increase (two [10%]). One patient had a treatment-related serious adverse event (aspartate aminotransferase 19-times higher than the upper limit of normal). No grade 4 or 5 treatment-related adverse events were reported. Interpretation Camrelizumab plus apatinib showed promising antitumour activity and acceptable toxicity and could be a salvage therapy option for the treatment of high-risk chemorefractory or relapsed gestational trophoblastic neoplasia. Immune checkpoint inhibitors combined with chemotherapy for heavily-treated patients and upfront use of camrelizumab plus apatinib for patients with high-risk gestational trophoblastic neoplasia are under investigation in phase 2 trials. Funding National Natural Science Foundation of China, Jiangsu Hengrui Pharmaceuticals.

This study aimed to determine the disease characteristics and prognosis of patients with primary mediastinal nonseminomas (PMNS) in a Surveillance, Epidemiology, and End Results (SEER) analysis.Demographic, treatment, and survival outcome data of cases with PMNS from 1975 to 2016 were retrieved. Cases with unknown variables mentioned in the analysis were excluded. Relative statistical methods were applied to analyze clinical characteristics and prognosis.A total of 587 PMNS patients met the selection criteria, 526 of whom were men. The mean age of patients was 28 (1-85) y. A total of 511 PMNS patients had validated subtypes, including 172 mixed germ cell tumors, 117 yolk sac tumors, 111 malignant teratomas, 70 choriocarcinomas, and 41 embryonal carcinomas. Patients with yolk sac tumors had the highest 3-y cancer-specific survival (CSS) rate (66.9%), while those with choriocarcinoma and embryonal carcinoma showed the worst prognosis. Surgery + chemotherapy (46.2%) was the most common and effective treatment for each subtype of PMNS. Multivariate Cox proportional hazards analysis identified embryonal carcinoma, malignant teratoma, choriocarcinoma, tumor size15 cm, nodal metastasis, and distant stage as risk factors. In contrast, surgery-based care and younger age were protective factors. Propensity score matching analysis revealed significant improvement in the 5-y CSS rate from 35.8% to 60.3% with surgery (P0.001). However, radiotherapy (P = 0.436) and chemotherapy (P = 0.978) showed no survival benefits.10 percent of the PMNS patients were female. Choriocarcinomas and embryonal carcinomas had the worst prognosis. Surgery was demonstrated to be the only way to prolong survival time. Chemotherapy and radiotherapy had minimal effects on prognosis.

Background Thyroid storm is an endocrine emergency and life-threatening condition discovered in 1926. There is no specific laboratory parameter that can differentiate or distinguish between thyroid storm and primary hyperthyroidism. Diagnosis is made on a clinical scoring system, including the Burch–Wartofsky point scale and Japanese Thyroid Association scoring system. The management is early diagnosis, immediate initiation of anti-thyroid medications, intensive care monitoring, and prevention of multiorgan failure. Case presentation A 30-year-old Pakistani female presented with complaint of headache, vomiting, and generalized weakness for 3 weeks. She had an episode of seizure-like activity at home, and so was rushed to the emergency department. A detailed thyroid examination revealed a soft, nontender gland with no enlargement or bruit and no exophthalmos. Her thyroid-stimulating hormone was extremely low, with high free triiodothyronine and thyroxine. Thyroglobulin was 425 ng/ml (normal reference range ≤ 55 ng/ml), and thyroid-stimulating hormone receptor antibody was 0.87 IU/L (normal reference range 0–1.75 IU/L). She had high levels of beta-human chorionic gonadotropin hormone on initial presentation. Transvaginal ultrasound showed no intrauterine pregnancy, but an echogenic focus was found adherent to the right ovary with no vascularity. With the chief complaint of headache, she underwent magnetic resonance imaging of the brain that showed multiple scattered hemorrhagic lesions in supratentorial and infratentorial brain parenchyma that were highly suspicious for metastases. Computed tomography scan of the chest, abdomen, and pelvis revealed multiple neoplastic lesions in the lung, liver, spleen, and kidneys. A Tru-Cut liver biopsy showed linear cores of liver tissue with metastatic carcinoma with morphological features consistent with choriocarcinoma. Our patient scored 65 on the Burch–Wartofsky point scale. As per the Japanese Thyroid Association scoring system, our patient met the criteria for a “definite thyroid storm.” She had initiated propranolol to achieve adequate control of her heart rate and dexamethasone. Carbimazole was started to control her thyroid function. Her thyroid function after 2 weeks of treatment showed significant improvement. Methotrexate and etoposide were given for choriocarcinoma. She made a good recovery and was discharged home. She will undergo rehabilitation along with ongoing chemotherapy (methotrexate and etoposide weekly till beta-human chorionic gonadotropin levels normalize). Unless her source of beta-human chorionic gonadotropin is carefully under control, she will continue to take anti-thyroid medications. Conclusion Choriocarcinoma is not only associated with hyperthyroidism but can induce thyroid storm. Beta-human chorionic gonadotropin is directly associated with promoting thyroid dysfunction. Patients with gestational trophoblastic disease should be under close surveillance to prevent thyroid storms.

Gestational trophoblastic disease (GTD) arises from abnormal placenta and is composed of a spectrum of premalignant to malignant disorders. Changes in epidemiology of GTD have been noted in various countries. In addition to histology, molecular genetic studies can help in the diagnostic pathway. Earlier detection of molar pregnancy by ultrasound has resulted in changes in clinical presentation and decreased morbidity from uterine evacuation. Follow-up with human chorionic gonadotropin (hCG) is essential for early diagnosis of gestational trophoblastic neoplasia (GTN). The duration of hCG monitoring varies depending on histological type and regression rate. Low-risk GTN (FIGO Stages I-III: score

Background Choriocarcinoma is a subtype of gestational trophoblastic disease, gestational trophoblastic neoplasia. Patients with brain metastasis are rare and information on the optimal treatment and patient outcome is limited. In order to improve the prognosis of this disease, accurate and timely treatments are very important for the patient of brain metastasis by choriocarcinoma. Case summary A 17-year-old unmarried girl was misdiagnosed with a cerebral hemangioma with intracranial hemorrhage in a local hospital after presentation with severe head pain. She underwent craniotomy three times for treatment. The pathological results of posterior intracranial hematoma showed choriocarcinoma, and the patient was diagnosed as choriocarcinoma (21 points in stage IV). After uterine artery embolization, etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine chemotherapy for 7 cycles, and whole brain radiotherapy, the patient achieved remission. She has been followed for 2 years with no signs of tumor recurrence. Conclusion For female patients of childbearing age with an intracranial hematoma, the possibility of brain metastasis by choriocarcinoma should be considered. It is necessary to obtain a detailed history, including menstruation, beginning age of first sex, contraception, etc. The level of β-human chorionic gonadotropin should be tested at the beginning, and a stratified treatment should be administered according to the International Federation of Gynecology and Obstetrics staging and World Health Organization prognostic scoring systems.

Mixed germ cell tumours (MGCT) of the ovary are malignant neoplasms of the ovary comprising of two or more types of germ cell components. Most of the malignant MGCT consists of dysgerminoma accompanied by endodermal sinus tumours, immature teratoma or choriocarcinoma. There are only few case reports of MGCTs with different combinations of malignant components. We present a very rare case of malignant MGCT in a 05 years old female child, who presented with difficulty in defecation for 6 months, swelling over sacral region for 2 months, along with bilateral inguinal swellings and difficulty in urination for 1 week. Swelling was firm, non-mobile & non-tender measuring 6.6x5 cm. On cytology it was diagnosed as malignant germ cell tumour, which was confirmed on histology as malignant MGCT (predominantly yolk sac tumour >90% and embryonal carcinoma (

Primary hepatic mixed germ cell tumor (GCT) is very rare, and less than 10 cases have been reported. We report a case of mixed GCT composed of a choriocarcinoma and yolk sac tumor, which occurred in the liver of a 40-year-old woman. A large mass was detected by computed tomography solely in the liver. Serum β-human chorionic gonadotropin (hCG) was highly elevated, otherwise, other serum tumor markers were slightly elevated or within normal limits. For hepatic choriocarcinoma, neoadjuvant chemotherapy was administered, followed by right lobectomy. Histologic features of the resected tumor revealed characteristic choriocarcinoma features with diffuse positivity for hCG in the syncytiotrophoblasts and diffuse positivity for α-fetoprotein and Sal-like protein 4 in the yolk sac tumor components. Primary malignant GCT in the liver is associated with a poor prognosis and requires specific treatment. Therefore, GCT should be considered during a differential diagnosis of a rapidly growing mass in the liver.

الملخص: إن سرطانة المبيض المشيمائية غير الحملية هي حالة سريرية نادرة للغاية. وهناك عدد قليل جدا من الحالات عالية الخباثة تم الإبلاغ عنها في الأدبيات في جميع أنحاء العالم. نظرا لندرة الورم، يتم تجاهل هذا المرض بشكل عام، مما يؤدي إلى تأخر التشخيص والعلاج. بالنسبة للأطباء المختصين، تشكل سرطانة المبيض المشيمائية غير الحملية تحديا تشخيصيا بسبب أعراضها السريرية غير المحددة. نقدم حالة فتاة تبلغ من العمر ١٦ عاما راجعت بألم في الحفرة الحرقفية اليمنى واختبار بول للحمل إيجابي. على الرغم من كونها غير نشطة جنسيا، تم تشخيص المريضة بحمل خارج الرحم وخضعت لعملية إسعافية جراحية بالمنظار. بعد ستة أسابيع، أظهر التحليل الهستوولوجي تشخيص سرطانة المبيض المشيمائية غير الحملية. وأظهرت تقييمات أخرى أن سرطانها قد تقدم بالفعل إلى المرحلة الرابعة. في هذا التقرير، يتم مناقشة الأعراض غير المحددة للمرض، والسمات الإشعاعية، والعلاجات الحالية واستراتيجيات السلامة الممكنة. Abstract: Non-gestational choriocarcinoma of the ovary is an extremely rare clinical condition. Very few cases of this high-grade malignancy of the ovary are reported in the literature worldwide. Given the rarity of the tumour, this disease is generally overlooked, which leads to delayed diagnosis and management. For the attending clinicians, the non-gestational choriocarcinoma of the ovary poses a diagnostic challenge due to its non-specific clinical presentations. A 16-year-old girl presented with pain in the right iliac fossa and with a positive urine pregnancy test. Despite being sexually inactive, the patient was diagnosed with an ectopic pregnancy and underwent emergency laparoscopic surgery. Six weeks later, the histopathological analysis revealed a diagnosis of non-gestational choriocarcinoma of the ovary. Further evaluations showed that her cancer had already advanced to stage IV. In this case report, the non-specific presentations of the disease, radiological features, current treatments, and possible safety strategies are discussed.

Malignant trophoblastic tumors (TO) include invasive and metastatic cystic drift, choriocarcinoma, TO of the placental bed, and epithelioid TO. They are rare, mainly in women of reproductive age, and most importantly, they are always associated with pregnancy. To date, the Blokhin National Medical Research Center of Oncology has accumulated a large and unique experience of modern diagnostics and treatment of patients with various forms of malignant TO. An obligatory stage of the examination is ultrasound diagnostics of the pelvic organs. In addition, performing an ultrasound examination during the treatment period, along with monitoring the level of chorionic gonadotropin, makes it possible to assess the effectiveness of treatment, diagnose tumor resistance and ascertain the onset of remission.

Background Choriocarcinoma is a highly malignant trophoblastic tumor. However, the awareness surrounding its atypical clinical presentation is insufficient. The presence of a solitary lung lesion without uterine lesions often leads to misdiagnosis or missed diagnosis, which in turn causes delayed treatment or even multiple metastases throughout the body. Case presentation We present the case of a 36-year-old female patient who was misdiagnosed with a lung abscess and received suboptimal anti-infective treatment. She then underwent left upper lobectomy and was misdiagnosed with lung cancer by abscess incision and drainage in thoracic surgery, however, the results after pleural effusion removal were suboptimal. During this time a breast nodule was found, and a large segment of the right breast was excised and misdiagnosed as breast cancer but was finally diagnosed as choriocarcinoma with multiple metastases of lung and breast. Multiple metastases were also detected in the head, liver, kidney, and bones. The patient underwent multiple adjuvant chemotherapies. The blood β-hCG level gradually declined to normal. When we reported this case, that is, seven months after the diagnosis, the patient was still alive, and the disease was stable without progress. Conclusion Choriocarcinoma with a solitary lung lesion as the first presentation and no lesions in the uterus is clinically rare. This may lead to a delay in diagnosis due to poor awareness of the disease and the appearance of multiple metastases throughout the body. Clinicians should be more aware of choriocarcinoma with an atypical presentation to reduce misdiagnosis and missed diagnosis.

Pregnancy with choriocarcinoma is a rare tumor. It is rare for neonates to survive the third trimester. This article reports the clinical data of a live fetal pregnancy with choriocarcinoma complicated by brain and lung metastases. The patient was admitted to the hospital for “menopause 28 weeks + 5 days, dizziness with nausea and vomiting 2 days.” After 5 hours of admission, the patient had sudden convulsions, urinary incontinence, and coma. A head computed tomography (CT) examination in the emergency department revealed a cerebral hemorrhage in the right occipital lobe and broke into the ventricular system with brain herniation. She was immediately transferred to the intensive care unit for the emergency cesarean section and intracerebral hematoma removal. A postoperative CT scan revealed that the tumor in the upper lobe of the right lung was considered lung cancer, with multiple metastases in both lungs. Postoperative pathology was metastatic choriocarcinoma tissue seen in the blood clot. Based on the pathological diagnosis of choriocarcinoma, a chemotherapy regimen was developed with 2 courses of EP regimen and 8 courses of combined EMA-CO chemotherapy regimen. The patients were followed up for 2 years and ultimately resolved.

High-risk gestational trophoblastic neoplasia (GTN) has an increased risk of developing chemoresistance to single-agent chemotherapy; therefore, the primary treatment should be a multiagent etoposide-based regimen, preferably EMA/CO. After remission (normalization of human chorionic gonadotropin - hCG), at least three consolidation courses of EMA-CO are needed to reduce the risk of relapse. Chemoresistance is diagnosed during treatment if hCG levels plateau/increase, in two consecutive values over a two-week period. When this occurs after remission, in the absence of a new pregnancy, there is a relapse. In both cases, after re-assessment of the extent of disease, EMA-EP is the most common chemotherapy choice. Even in these cases, remission rates are high. After remission is achieved, hCG should be measured monthly for a year. Pregnancy can be allowed after 12 months from remission. The follow-up of these patients in referral centers minimizes the chance of death from this disease and should be encouraged.

Gestational trophoblastic disease (GTD) is a heterogeneous group of pregnancy-related disorders characterized by abnormal proliferation of trophoblastic tissue. It encompasses the premalignant partial and complete hydatidiform mole but also the malignant invasive mole, choriocarcinoma, placental-site trophoblastic tumor, and epithelioid trophoblastic tumor. The clinical presentation changed to earlier detection after the introduction of first trimester ultrasounds. Patients are often asymptomatic, but vaginal bleeding continues to be the most common presenting symptom. Other symptoms can develop in the case of metastatic disease. Ultrasound, serum human chorionic gonadotrophin, and sometimes additional imaging such as CT, MRI, or PET can confirm the diagnosis and stage of disease. Familiarity with the pathogenesis, classification, imaging features, and treatment of GTD facilitates diagnosis and appropriate management.

Low-risk gestational trophoblastic neoplasia (GTN), defined as FIGO/WHO score 0-6, is highly curable with an overall survival rate, which is approximately 100%. For most low-risk GTN patients, first-line single-agent chemotherapy with either methotrexate or actinomycin-D is recommended with overall complete human chorionic gonadotrophin (hCG) response rates of 60%-90% in mostly retrospective, non-randomised studies. The few randomised trials that exist are not appropriately powered or designed to define the optimal first-line treatment. Approximately 25%-30% of low-risk patients will develop resistance to initial single-agent chemotherapy with an increase in the FIGO score, a diagnosis of choriocarcinoma, higher pre-treatment hCG and the presence of metastatic disease being associated with an increase in the risk of resistance. The optimal treatment of patients scoring WHO 5 and 6 remains poorly defined given that approximately 70%-80% of these patients develop resistance to first-line single-agent chemotherapy, and there is an urgent need to refine the FIGO/WHO scoring system so that these patients can be identified for more intensive therapy from the outset. Despite this, almost all low-risk patients who experience treatment failure with first-line monotherapy will be cured with either sequential single-agent chemotherapy or multiagent chemotherapy with or without surgery. Given the associated increased short and longer-term toxicities associated with multi-agent chemotherapy, promising strategies to reduce the exposure of women to combination chemotherapy in low-risk disease have been investigated, including the use of carboplatin and immune check-point inhibitors. Further evaluation is required to define optimal patient selection, particularly with the use of immunotherapeutic agents given their significant increased costs and lack of longer-term safety data. Although there is a clear need to revise the FIGO/WHO (2000) scoring system, consistent international use of this is recommended to facilitate the comparison of data along with future focus in the development of international collaborative translational and clinical research, including randomised controlled trials.

Hydatidiform mole (HM) occurs in 1:500-1000 pregnancies and are generally characterised as a benign proliferative disorder of chorionic villous trophoblast. HM belongs to the group of disorders, collectively known as gestational trophoblastic disease (GTD), which include invasive mole, choriocarcinoma, placental site trophoblastic tumour and epitheloid trophoblastic tumour. Patients with HM are at increased risk of developing these malignant forms and hence accurate diagnosis is very important for monitoring persistent diseases and informing correct patient management. In this review, we describe the current model for HM follow-up in the UK, with special emphasis on the in-house human chorionic gonadotrophin (hCG) radioimmunoassay (RIA) currently employed for monitoring women in our programme. We briefly discuss the structure, function and significance of hCG monitoring in GTD and the limitations and benefits of the current assays used for measuring oncology hCG. In particular, we describe the preliminary work evaluating a replacement antibody for the current gold-standard UK-RIA method.

The World Health Organization (WHO) estimates that sub-Saharan Africa compromises 64% of the global human immunodeficiency virus (HIV) burden. Over the last decade, there has been steady progress in the reduction of acquired immunodeficiency syndrome (AIDS)-related deaths and a more gradual progress in the reduction of new HIV infections globally. The largest reduction in HIV infections and AIDS-related deaths occurred in Southern and Eastern Africa. Gestational trophoblastic disease (GTD) comprises a spectrum of pregnancy-related illnesses with cure rates near 90%. To date, no clear association exists between HIV and GTD. Response to treatment for gestational trophoblastic neoplasm is favorable, but in HIV-positive patients, the extent of metastatic disease, low CD4 counts and poor performance status compromise treatment outcome and survival.

Background Metastatic choriocarcinoma in the third trimester of pregnancy is extremely rare. Case presentation A 25-year-old Chinese woman (gravida 3, para 0) who was 28 weeks pregnant was admitted for sudden convulsion, aconuresis, and unconsciousness. The decision was made to perform an emergency cesarean delivery and craniotomy, hematoma clearance, and decompression. Pathological examination confirmed choriocarcinoma with brain metastasis. The patient underwent chemotherapy with the etoposide, cisplatin (EP) and etoposide, methotrexate and dactinomycin alternating with cyclophosphamide and vincristine (EMACO) regimens. A satisfactory result was achieved. Conclusions When encountering intracranial mass or bilateral pulmonary nodules in a pregnant woman, especially one in the third trimester, metastatic choriocarcinoma should be considered.

Background: Gestational trophoblastic disease (GTD) is an uncommon complication of pregnancy. It is of clinical and epidemiological interest partly because of its good prognosis if detected and managed early. Objective: This study was to determine the prevalence, clinical presentation, management outcome and histologic types of GTDs at University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. Methodology: A five-year retrospective study of histologically confirmed cases of GTDs managed in UMTH was undertaken. Folders of patient treated for GTD during the study period served as source of data. Statistical analysis was done using Statistical Package for the Social Sciences. Results: There were a total of 47 (38 molar and 9 choriocarcinoma) cases of GTDs that were diagnosed and managed at UMTH. However, only 40[31(77.5%)] molar and [9(22.5%) choriocarcinoma] case files were retrieved. 55% of the GTDs were complete hydatidiform mole, 22.5% partial hydatidiform mole and 22.5% choriocarcinoma. There was no case of invasive mole or placental site trophoblastic tumour noted. There were 15,426 deliveries in UMTH during this period giving the incidence of GTDs as 3.0 per 1000 deliveries or 1 in 328deliveries. The mean (SD) age of the patients was 30.5 ± 5.6years. Only 3(7.5%) of the patients were below 20 years of age and those who were at least 40 years of age constituted 8(20%). Low parity constituted 62.5% of the patients while 12.5% and 2.5% were nullipara and primipara respectively. The mean gestational age (SD) at presentation was 16.5±6.2 weeks. The common clinical presentations were amenorrhoea (100.0%), abnormal vaginal bleeding (97.5%), lower abdominal pain (90%) and passage of grape-like vesicles (45.0%). Only 6(15.0%) complied with the follow-up protocol for one year, while 25(62.5%) of the patients did not observe the follow-up protocol. Anaemia was the commonest complication observed. Conclusion: Gestational trophoblastic disease is relatively common in our center with an incidence of 3.0 per 1000 deliveries and 1.48% of our gynaecological admissions. Adequate patient counseling and compliance to follow-up are recommend for good outcome. Keywords: Prevalence, gestational trophoblastic disease, Hydatidiform mole, Choriocarcinoma, Maiduguri.

Study Objective Pediatric ovarian neoplasms with imaging appearance suggestive of teratoma are often presumed to have low risk of malignancy. We assessed the pre-operative imaging appearance of pediatric malignant ovarian germ cell tumors (MOGCT) and the presence of associated teratoma in a series of MOGCT. Design Retrospective review of clinical and pathology data. Setting Multicenter trial for extracranial malignant germ cell tumors in young female individuals by the Children's Oncology Group (COG study AGCT0132) that included yolk sac tumor, embryonal carcinoma and choriocarcinoma. Participants Female individuals 0-20 years of age at enrollment with ovarian primary nonseminomatous malignant germ cell tumors. Interventions Review of data forms, including prospectively collected surgical checklist documenting imaging characteristics of the tumor, and review of pathology reports. Main Outcome Measures Description of imaging appearance and frequency of mixed histology with benign teratoma elements. Results A total of 138 female individuals (11 months to 20 years of age) had primary ovarian tumors. Imaging appearance and pathology information were available for 133 patients. Among the 133 patients, tumor appearance was solid (10.5%), solid with calcification (3.0%), mixed cystic and solid (58.7%), mixed cystic and solid with calcification (24.8%), and unknown (3.0%). In all, 54% had elements of teratoma in addition to malignant histology. Conclusion Mixed cystic and solid appearance with or without calcification was seen in 83.5% of pediatric ovarian malignant germ cell tumors. Associated benign teratoma was common. The presence of a mixed cystic and solid appearance on preoperative imaging should not dissuade the surgeon from obtaining preoperative serum markers and undertaking complete surgical staging.

OBJECTIVE: To describe the clinical and ultrasound characteristics of three types of rare malignant ovarian germ cell tumor: embryonal carcinoma, non-gestational choriocarcinoma and malignant mixed germ cell tumor. METHODS: This was a retrospective multicenter study. From the International Ovarian Tumor Analysis (IOTA) database, we identified patients with a histological diagnosis of ovarian embryonal carcinoma, non-gestational choriocarcinoma or malignant mixed germ cell tumor, who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 2000 and 2020. Additional patients with the same histology were identified from the databases of the departments of gynecological oncology in the participating centers. All tumors were described using IOTA terminology. Three examiners reviewed all available ultrasound images and described them using pattern recognition. RESULTS: One patient with embryonal carcinoma, five patients with non-gestational ovarian choriocarcinoma and seven patients with ovarian malignant mixed germ cell tumor (six primary tumors and one recurrence) were identified. Seven patients were included in the IOTA studies and six patients were examined outside of the IOTA studies. The median age at diagnosis was 26 (range, 14-77) years. Beta-human chorionic gonadotropin levels were highest in non-gestational choriocarcinomas and alpha-fetoprotein levels were highest in malignant mixed germ cell tumors. Most tumors were International Federation of Gynecology and Obstetrics (FIGO) Stage I (9/12 (75.0%)). All tumors were unilateral, and the median largest diameter was 129 (range, 38-216) mm. Of the tumors, 11/13 (84.6%) were solid and 2/13 (15.4%) were multilocular-solid; 9/13 (69.2%) manifested abundant vascularization on color Doppler examination. Using pattern recognition, the typical ultrasound appearance was a large solid tumor with inhomogeneous echogenicity of the solid tissue and often dispersed cysts which, in most cases, were small and irregular. Some tumors had smooth contours while others had irregular contours. CONCLUSIONS: A unilateral, large solid tumor with inhomogeneous echogenicity of the solid tissue and with dispersed small cystic areas in a young woman should raise the suspicion of a rare malignant germ cell tumor. This suspicion can guide the clinician to test tumor markers specific for malignant germ cell tumors. © 2020 International Society of Ultrasound in Obstetrics and Gynecology. ispartof: ULTRASOUND IN OBSTETRICS & GYNECOLOGY vol:57 issue:6 pages:987-994 ispartof: location:England status: published

Gestational choriocarcinoma (GCC) is a highly malignant but rare tumour originating in the trophoblastic tissue. It is associated with high maternal morbidity and mortality especially when there is a delay in diagnosis and treatment. This is the only female malignant condition that is curable with chemotherapy following early treatment. The objective of this study was to retrospectively determining the incidence of choriocarcinoma, its clinical presentations, risk factors, the interval between the antecedent case and time of diagnosis, treatment options and outcome in ESUT-TH. The folders of patients treated for GCC over the period of the study served as source of data. Results showed that the incidence of GCC was 0.1% or 1 in 1731 deliveries. It further shows that GCC accounted for 0.2% of gynaecological admission in ESUT-TH. Abnormal bleeding per vaginum and amenorrhoea were the commonest presenting symptoms discovered in this study, while other clinical presentations noted include; isolated vaginal nodule, ovarian mass and haemoptysis. Molar gestation and miscarriage were the risk factors discovered in this study, lungs were discovered to be the commonest site of metastasis. It is concluded that gestational choriocarcinoma is a rare malignancy in ESUT-TH, South-East Nigeria with minor case fatality. Keywords: Gestational, Choriocarcinoma, incidence.

Aim Previous studies have indicated that early metastasis is a major cause of mortality in patients with choriocarcinoma. However, what determines whether early metastasis of choriocarcinoma has occurred is unknown. The emerging role of miRNA in regulating cancer development and progression has been recognized. miR-373 has been shown to play pivotal roles in tumorigenesis and metastasis. However, whether miR-373 functions to promote choriocarcinoma metastasis is not clear. The purpose of this study is to determine the function of miR-373-3p in the progression of this cancer. Methods In this study, we first compared epithelial-mesenchymal transition (EMT)-related markers, which were inversely correlated with miR-373-3p expression in trophoblast and choriocarcinoma cell lines. Using PCR and Western blot, upregulation of miR-373-3p was observed to inhibit EMT progression. Similarly, gain- and loss-of-function studies revealed that ectopic miR-373-3p overexpression inhibited the migration by transwell methods of choriocarcinoma cells. Results Our results revealed that miR-373-3p acted as an EMT inhibitor in JEG-3 and JAR cells; this was due to its mediation of the transforming growth factor-β (TGFβ) signaling pathway, which was responsible for EMT. miRNA microarray analysis demonstrated that miR-373-3p interacted with the 3' untranslated region of TGFβR2 mRNA, and then Western blot and dual-luciferase reporter gene assays verified this interaction. Conclusion Our findings suggest that miR-373-3p upregulation partly accounts for TGFβR2 downregulation and leads to a restraint of EMT and migration. miR-373-3p may therefore serve as a valuable potential target in the treatment of choriocarcinoma.

Cannonball lesions are numerous, well-circumscribed, round pulmonary lesions and may be identified on plain radiograph or advanced imaging. This morphology can be associated with infectious causes, rheumatologic disease and metastatic disease. Classically, when cannonball lesions are associated with metastatic disease, they are seen in renal cell carcinoma and choriocarcinoma. We report a case of a 62-year-old Middle Eastern male who presented with shortness of breath, chest pain and fatigue and was found to have bilateral multiple pulmonary cannonball lesions and mass in the pancreas. Biopsy of one the lung lesions was consistent with pancreatic cancer. Our case adds to the limited literature available regarding cannonball lung lesions in the setting of pancreatic cancer. Health care providers should be aware of the various etiologies of cannonball lesions.

Embryonic carcinoma (EC) cells were the first pluripotent cells identified. These cells were derived from malignant germ cell tumors called teratocarcinomas. Embryonal carcinoma also affects young patients but is far less common than yolk sac tumor in the ovary and, when encountered, is always a component of a mixed germ cell tumor.1 Malignant germ cell tumors are subdivided into dysgerminoma and nondygerminomatous tumors. The most common types of nondysgerminomatous tumors are yolk sac and immature teratoma. Mixed germ cell tumors with embryonal carcinoma, nongestational choriocarcinoma, and polyembryoma are less common. Embryonal carcinomas, though rare, are one of the most malignant cancers arising in the ovary.2 In this case report, a 4,5-year-old girl was diagnosed with suspected embryonal ovarian carcinoma after complaints having menstruation for three months, develop pubic hair and breast. This patients later had laparotomy surgical staging and undergoing chemotherapy.

Background Pure ovarian choriocarcinoma can be gestational or nongestational in origin. Nongestational pure ovarian choriocarcinoma is extremely rare and the prognosis is thought to be worse than that of the gestational type in patients with metastatic disease. We present a case of metastatic pure ovarian choriocarcinoma with poor prognosis in which the origin was identified as nongestational by DNA short tandem repeat (STR) analysis. Case presentation A nulliparous woman in her thirties with metastatic choriocarcinoma was referred to our hospital after initial treatment proved unsuccessful. Two months earlier, she had undergone brain tumor resection and histological examination confirmed choriocarcinoma. Serum human chorionic gonadotropin (hCG) concentration at initial diagnosis was 5030 IU/L. Two cycles of a combination chemotherapy regimen of methotrexate, etoposide, and actinomycin-D (MEA therapy), which is commonly used for gestational choriocarcinoma, was administered. However, the disease could not be controlled. Imaging modalities at presentation revealed tumor present in the left ovary and left lung, but not in the uterus, which led us think that the choriocarcinoma was nongestational. Bleomycin, etoposide, and cisplatin (BEP therapy) which is commonly used for nongestational choriocarcinoma (malignant germ cell tumor) and surgical resection of the uterus, bilateral ovaries, and an affected part of the left lung led to the nadir level of hCG, but the tumor relapsed and levels of hCG again increased. To investigate the origin of choriocarcinoma, we performed DNA STR analysis of tumor cells and oral mucosal cells. Analysis revealed the origin of the choriocarcinoma as nongestational, as the genotype of tumor cells entirely corresponded with that of oral mucosal cells. BEP therapy and chemotherapy regimens administered for nongestational choriocarcinoma and gestational choriocarcinoma proved ineffective, and the patient died 21 months after diagnosis of metastatic choriocarcinoma. Conclusion Metastaic nongestational pure choriocarcinoma of ovary is an extremely rare and an aggressive disease, frequently resulting in poor outcome.

Introduction: Gestational Trophoblastic Disease (GTD) is a term used for a group of pregnancy-related tumours. These consist of various tumours and tumour like lesions characterized by proliferation of trophoblastic tissue. Amongst GTD, hydatidiform moles are the most common form. These lesions sometimes may develop into invasive moles, or, in rare cases, into choriocarcinoma. Risk factors of GTD include extreme of reproductive age, multiparity, smoking, alcohol consumption, lower socioeconomic class etc. Materials and Methods: The present study was descriptive, observational, analytical type done in Department of Pathology at M.P. Shah Medical College Jamnagar. All cases clinically suspected of GTD were included and its correlation with serum beta hCG was studied. The cases of GTD were classified according to WHO classification. Estimation of serum beta hCG level was done by using Indirect Sandwich Enzyme Linked Immunosorbent Assay (ELISA). Results: During study period of 1 year from October 2019 to September 2020, 150 sample received out of which 16 cases were diagnosed as GTD. Most of the cases were of hydatidiform moles, few cases of choriocarcinoma and Placental Site Trophoblastic Tumour (PSTT). The common clinical presentation was per vaginal bleeding and amenorrhea. In majority of cases beta hCG levels were between 50,000 to 100000 mIU/ml. The correlation between beta hCG level and GTD was done. Conclusion: Pregnant females clinically presenting with abnormal vaginal bleeding must be evaluated for GTD. Histopathological examination and serum beta hCG level are helpful for confirmatory diagnosis. Follow up beta hCG level is very useful indicator to detect these lesions and its recurrences.

Background: Gestational trophoblastic diseases (GTD) are a spectrum of lesions occurs as sequelae of pregnancy and it included non-neoplastic and neoplastic lesions in varied proportions. Multi system approach is warranted to diagnose GTD and studies proposes that clinico-pathological correlation aids in effective diagnosis of GTD in conjunction with ultrasonographic studies. Aim: To analyze the incidence of GTD, clinical characteristics, histopathological evaluation with an attempt to study clinico-radio-pathological correlations in different forms of gestational trophoblastic diseases Methodology: The study was conducted in Department of Pathology, Mahatma Gandhi Medical College & Research Institute, Puducherry from duration between 2014 to 2019 for a period of 6 years as a Quantitative observational and analytical study including all abnormal cases of gestational related histopathological specimens (Products of conception, evacuation, hysterectomy) referred to the laboratory from clinical side The clinical details including patients obstetric history, biochemical parameters like hCG levels, ultrasound findings, etc. were documented to attempt correlation Results: The study analysed 160 cases and showed hydatidiform mole (130 cases) was the common GTD followed by choriocarcinoma (13 cases)and Placental site trophoblastic tumour (17 cases). Beta HCG was the sensitive marker in predicting GTD. Clinico-pathological correlation proved to be significant in directing the clinicians for planning treatment Conclusion: Any pregnant women presenting with abnormal uterine bleeding should be evaluated for underling presence of any GTD. Histopathological evaluation stays as gold standard procedure whereas ultrasonography is significant in detecting GTD lesions preoperatively thereby aids clinicians in proper planning of treatments. Keywords: Gestational Trophoblastic diseases, Mole, Histopathology, Ultrasonography choriocarcinoma.

Germ cell tumors (GCTs) comprise a wide spectrum of benign and malignant tumors. Neonatal GCTs are predominantly teratomas (mature or immature), which are typically cured with surgery alone. Relapses are infrequent even in the setting of microscopic residual disease; therefore, negative surgical margins at the cost of significant morbidity are not recommended. In neonates with metastatic malignant disease or malignant disease for which upfront surgical resection is not feasible without significant morbidity, an initial biopsy followed by neoadjuvant chemotherapy and delayed surgical resection is recommended. Carboplatin-based regimens should be considered when chemotherapy is indicated.

Germ cell cancers are the most common solid tumors among men between 15 and 40 years. Non-seminomatous germ cell tumors (NSGCTs) represent a unique and exclusive cohort of germ cell tumor patients. Non-seminoma can harbor different histologic components. The most commonly found histologies are embryonal cell cancer, teratoma, yolk sack tumor and choriocarcinoma, as well as teratocarcinoma and seminoma, in combination with non-seminomatous germ cell tumors histologic types. The clinical definition of stage I non-seminoma is the absence of metastatic lesions on imaging and normal tumor markers. The cure rate for clinical stage I NSGCT is 99% and this can be achieved by three therapeutic strategies: Active surveillance with treatment at the time of relapse, retroperitoneal lymph node dissection or adjuvant chemotherapy. The balancing of these various strategies should always be based on an individual risk profile of NGSCG patient depending on the lymphovascular invasion of the tumor.

An immature teratoma is a teratoma that is known to contain immature anaplastic elements and is often known as malignant teratoma. Around 95% of testicular cancer is germ cell tumor (GCT). GCT is further divided into Non seminomatous GCT (NSGCT) and Seminoma. NSGCT include choriocarcinoma, embryonal carcinoma, yolk sac tumor, teratoma and mixed tumor. Among these only 2–6% of teratoma is pure teratoma. Pure teratoma can be subdivided into prepubertal and post pubertal. Among these two subgroups, the prognosis is also different. We report here a rare case of pure post-pubertal immature teratoma.

Gestational choriocarcinoma (GC) is an uncommon malignant tumor consisting of trophoblastic cells. The lungs, liver, and central nervous system are the most common metastatic sites for this disease. However, splenic metastasis is unusual and might result in spontaneous rupture. Symptoms associated with splenic rupture may be the first presentation of malignancy. A thorough medical history and examination are necessary to detect the primary lesion. Herein, we present a case of a 23-year-old female who had splenic rupture secondary to choriocarcinoma metastasis. Although the emergency condition had been solved, the patient died 1 month after due to brain metastasis. The goal of this article was to report a new case of spontaneous splenic rupture caused by choriocarcinoma metastasis and to review the existing literature on splenic metastases associated with GC, including the epidemiology and etiology.

Background: Many literature reviews report vitamin E supplementation as a benefit chemopreventive and adjuvant therapy in breast and prostate cancers. We investigated in the present work, alpha-tocopherol (α-T) expression (the current active form of vitamin E) from tissues of Congolese patients neither smokers nor alcohol drinkers and without intake antioxidant vitamins supplement. Methods: α-T was analysed in one normal placenta of nine weeks of gestation and in nineteen cancerous tissues, including seven breast cancers, six prostate cancers, and six gestational choriocarcinomas. The study was performed by immunohistochemistry method after diagnosis confirmation by histological analysis. Results: α-T staining in membrane cells and collagen fibers presented a moderate expression in healthy sections of tissues (positive control), but the labelling was strong in breast, prostate adenocarcinomas, and in choriocarcinomas. Conclusion: Tumors immunohistochemistry of α-tocopherol in breast, prostate cancers and in choriocarcinoma show elevated immunostaining suggesting a probable oncogenic effect of the micronutrient.

Depending on the developing laparoscopic technique and experience, the treatment of cesarean scar choriocarcinoma can be safely performed laparoscopically by experts.

Choriocarcinoma is a subtype of gestational trophoblastic disease. It is a very rare neoplasm, with incidence of about 1 case in 40.000 pregnancies. Gestational form of choriocarcinoma arises most commonly after abortion, while nongestational form develops from pluripotent germ cells. Choricarcinoma is highly malignant and highly chemosensitive type of tumor. A 43-year-old patient diagnosed with extra uterine pregnancy in September 2017 was treated with methotrexate with no response and had surgical removal of right Fallopian tube. Choriocarcinoma was diagnosed one and a half year after extra uterine pregnancy. Radiological imaging before treatment showed pulmonary and inguinal lymph node metastases and tumor invasion of the anterior uterine wall. Surgery was performed due to heavy bleeding and uterine wall invasion. As high risk patient she received chemotherapy. She was followed radiologically and her serum ?-HCG was monitored. Refractivity to the chemotherapy protocol during treatment was observed. Therapy response was achieved after administration of EMA-EP protocol modification i.e. three consecutive negative follow-up values of ?-HCG were obtained and radiological findings were disease free. One month after treatment patient had no signs of disease and ?-HCG level was normal.

Objective Choriocarcinoma is a rare malignant disease that is usually associated with a gestational event. Kidney metastasis might be misdiagnosed as renal cell carcinoma or kidney abscess. To the best of our knowledge, only 13 cases of cutaneous metastasis of choriocarcinoma have been reported in the literature so far. We report a case of choriocarcinoma that manifested with multiple metastases to the lung, skin, kidney and brain. Case report: We reported a case of a 37-year-old woman with a history of hydatiform mole, with symptoms of renal colic and abnormal findings on the skin. Chest X-ray revealed visible focal change 80 mm in diameter, located in the left lung area. The CT exposed in both kidneys multiple hypodense foci, 32 mm in size, suggesting multifocal abscesses with disruptions and perforation to paranephric area. Due to the presence of and temporary loss of vision in the right eye head CT was performed revealing metastatic changes in the brain. The diferential diagnosis between renal cancer, lung carcinoma and choriocarcinoma was achieved only after surgical removal skin lesion. This was the first time in our experience with choriocarcinoma. Immunohistochemically, the analysis was positive for beta hCG, cytokeratin AE1/AE, CK 8/18, CD10, EMA, alfa 1-inhibin and negative for protein 63, CD30 and CD117. Serum hCG level was 394590,0 mIU/mL. Conclusion Conclusions: Choriocarcinoma should be taken into consideration when associated symptoms and significantly elevated blood levels of β-hCG were identified.

Introduction: Gestational trophoblastic diseases include a spectrum of pregnancy-related diseases caused by abnormal proliferation of the placenta. The main aim of this study was to correlate ultrasound imaging with histopathological findings. Method: This is the retrospective chart review of findings of transabdominal ultrasonography in clinically suspected gestational trophoblastic diseases which were confirmed by histopathology after the evacuation of a product of conception during 3 years from 2016 to 2019 at Patan Hospital, Patan Academy of Health Sciences Nepal. The accuracy of sonography was correlated with histopathological findings and analyzed by Fisher’s Exact or Pearson’s Chi-square tests. The study was approved ethically. Result: Among 155 clinically suspected gestational trophoblastic diseases, ultrasonography was accurate in 141(91.0%) and confirmed by histopathology; 14(9.0%) were non-molar miscarriages. In 141 histologically confirmed trophoblastic disease, 110(71.0 %) were partial mole, 15(9.7%) complete mole, 12(7.7%) invasive mole and 3(1.9 %) persistent mole, and 1(0.6%) choriocarcinoma. Snowstorm appearance and absence of fetus were statistically significant ultrasonography findings. Conclusion: The ultrasound is a reliable non-invasive first-line imaging modality for the diagnosis of gestational trophoblastic diseases and had an accuracy of 91% as confirmed by histopathology in this study.

Hyperreactio luteinalis is a rare entity arising in pregnancy and in the setting of gestational trophoblastic diseases (ie choriocarcinoma, molar pregnancy) that presents with, typically, bilateral ovarian enlargement due to numerous follicle cysts. While the phenomenon is benign and spontaneously regresses following delivery or treatment, a specimen may be seen in pathology when oophorectomy or cystectomy is performed to exclude malignancy or to manage acute complications such as torsion. Such resections may exhibit overlapping microscopic features with cystic granulosa cell tumors. We thus reviewed 10 cases of hyperreactio luteinalis in the setting of pregnancy, the largest pathologic cohort to date, to highlight notable features of this disorder. Patients ranged from 22 to 30 yr old. Most patients (n=6) presented at time of cesarean section with incidentally discovered ovarian masses. Three patients presented in the postpartum period, and 1 underwent surgery at 28 wk gestation due to the finding of a unilateral ovarian mass. The ovaries ranged from 8.5 to 29 cm and were multicystic and bilateral in 8 of the cases. Histologic examination demonstrated multiple, variably sized cystic follicles lined by a granulosa cell layer of varying thickness and theca cells with marked eosinophilic cytoplasm. Stromal edema was often prominent, with theca cells occasionally noted in nests, cords, and as single cells in foci of edema. Mitoses were generally seen more often in the granulosa cell layer (mean=2.6 per high power fields) compared with the theca cell layer (mean=1 per 10 high power fields). This series documents the key features of hyperreactio luteinalis that differentiate it from the other benign mass forming lesions encountered in pregnancy, most notably large solitary follicle cyst of pregnancy and puerperium, as well as cystic granulosa cell tumors, especially the juvenile variant, which may also present during pregnancy. Of particular use in differentiating them from juvenile granulosa cell tumor is the absence of pale or vacuolated cytoplasm and solid growth of granulosa cells in cases of hyperreactio luteinalis.

Neoplastic cerebral aneurysms (NCAs) are highly rare lesions characterized by invasion of cancerous cells within the wall of an artery leading to aneurysm formation. While NCAs caused by myxomas are well characterized in the clinical literature, rarer etiologies have also been reported and are typically associated worse clinical outcomes. We performed the first PRISMA-compliant systematic literature review of true, non-myxoma neoplastic cerebral aneurysms using the PubMed/MEDLINE, Embase, Scopus, and Google Scholar databases. Data of interest included age, sex, aneurysm size, number of aneurysms, aneurysm location, neoplasm type, aneurysm treatments, cancer treatments, risk of rupture, intracerebral hemorrhage prevalence, subarachnoid hemorrhage prevalence, and survival at 90 and 180 days. A total of 50 studies met our inclusion criteria. The mean age of the patient population was 37.4 years (SD: ±16.8) and had an overall female preponderance (39/50, 78%). Of these NCA cases, 29/50 (58.0%) were choriocarcinomas, 10/50 (20.0%) were related to lung cancer, and 11/50 (22.0%) had other origins of variable pathologies. 90-day survival rates were 60.0% (15/25) for choriocarcinomas, 28.6% (2/7) for the lung cancer group, and 14.3% (1/7) for the other origins group. 180-day survival rates were 52.0% (13/25) for the choriocarcinoma group, 14.3% (1/7) for the lung cancer group, and 0% (0/7) for the other origins group. Prognosis of NCA patients ultimately depends on the course of disease progression and cancer management. Further research is needed to better understand optimal treatment modalities for patients with NCAs.

BACKGROUND Choriocarcinoma is an infrequent entity and the most aggressive subtype of germ-cell tumors. Because of early metastatic spread and rapid disease progression, choriocarcinoma patients display poor prognosis. Although etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) regimen is widely used to treat gestational trophoblastic tumors in females, its role in treating male choriocarcinoma is seldom reported. CASE SUMMARY A 32-year-old man was diagnosed with burned-out primary germ cell tumors (GCT) with retroperitoneum, liver and lung metastases. Biopsy of the liver revealed pure choriocarcinoma. The patient received bleomycin, etoposide, and cisplatin chemotherapy. After two cycles of treatment, response evaluation revealed the mixed response. EMA-CO regimen was used in the second-line therapy. After eight cycles, the patient showed a potentially resectable state and thus, all residual masses were surgically removed. The patient was completely cured, and 10 years later, he is leading a healthy life without complications. CONCLUSION This paper is the first case of high-risk nonseminomatous GCT in a male patient to be successfully treated with the EMA-CO regimen. The EMA-CO regimen can be used actively in patients with high-risk nonseminomatous GCT.

Highlights • Gestational Throphoblastic Neoplasms (GTN) includes a spectrum of pregnancy-related disorders of either benign or malignant. • Gestational choriocarcinoma in a patient with a previous history of IBD could have occurred in three different scenarios. • Dedifferentiation is the most accepted mechanism introduced to explain development of primary choriocarcinoma of colorectal origin. • Surgical resection with lymph node dissection is the standard of treatment. • Colorectal choriocarcinoma is considered pathologically similar to choriocacinoma of GTN, thus chemotherapeutic regimens are the same., Introduction Primary rectal choriocarcinoma is an extremely rare malignancy. The association of these neoplasms in patients with inflammatory bowel disease (IBD) has not been reported. Presentation of case A 34-year-old female with history of Ulcerative Colitis (UC) gave birth to a male fetus. She had postpartum bleeding and high level of beta-human chorionic gonadotropin (βhCG) was detected. Although initial investigations failed to confirm molar pregnancy, abnormal uterine bleeding and high βhCG level necessitate chemotherapy administration. She did not respond to chemotherapy sessions accordingly. Meanwhile, the patient experienced rectorrhagia and colonoscopy revealed a firm submucosal polypoid lesion 8–10 cm from the anal verge. The multidisciplinary team candidate the patient for total proctocolectomy and ileal pouch anal anastomosis. Although postoperative course was uneventful and βhCG level dropped but it showed a rising pattern in follow ups. Chemotherapy was planned but there was not suitable response. Unfortunately, the patient passed away 20 months after the initial diagnosis. Discussion Pathology report indicated the coexistence of moderately differentiated tubular adenocarcinoma and choriocarcinoma. We assume previous history of UC might have put her at higher susceptibility to develop carcinoma and this poorly differentiated carcinoma has led to choriocarcinoma. Considering the fact that in most cases of colorectal choriocarcinoma, choriocarcinomatous differentiation was found alongside colonic adenocarcinoma made dedifferentiation theory to be the most acceptable explanation. Conclusion The adenocarcinoma of the colon and rectum in the setting of IBD may become so dedifferentiated that gain some characteristics of germ cell tumors.

Metastatic brain tumors are the rare cause of intracerebral hemorrhage in the young. In this study, we present a case of a 24-year-old woman who suffered from brain and lung metastatic choriocarcinoma with intracerebral hemorrhage as initial presentation. Head computed tomography showed an irregular hematoma of the right frontal lobe and enlarged within 1 month. Chest X ray showed a mass in the right lung. This patient responded well with combined treatment with craniotomy for evacuation of hematoma, multidrug chemotherapy and lobectomy. This case report discusses a rare phenomenon of hemorrhage metastasis in the brain from choriocarcinoma. The better knowledge of this entity would facilitate earlier diagnosis and improve the outcome.

Background Choriocarcinoma is a highly malignant trophoblastic tumor that presents with early symptoms similar to those of an ectopic pregnancy. Here we present a patient with suspected ectopic pregnancy diagnosed by laparoscopic surgery in our hospital. The patient was found to have choriocarcinoma that had metastasized to the lumbar muscle and presented with symptoms similar to those of an ectopic pregnancy. Case summary The patient was a 34-year-old female who complained of amenorrhea lasting 53 d, 7 d of right lower back pain, and 3 d of right lower abdominal pain. Transvaginal ultrasonography revealed the absence of a gestational sac in the uterus and a mass in the left adnexa. After 6 d of re-examination, ultrasound and computed tomography (CT) examination were performed on the mass located in the left adnexa area. We also noted that the patient's serum β-human chorionic gonadotropin (hCG) level was increased. Considering an ectopic pregnancy, we performed a laparoscopy and hysteroscopy. During the operation, a left ovarian mixed echogenic mass approximately 2.5 cm × 2.0 cm with no villous tissue was found. Postoperative levels of serum hCG continued to increase. Lung CT examination showed lung nodules. Both CT and magnetic resonance imaging showed a mixed echogenic mass in the lumbar muscle. Considering lumbar metastasis of choriocarcinoma, six courses of cisplatin, dactinomycin, and etoposide chemotherapy were given after surgery. The patient's serum β-hCG level decreased to normal and the mixed echogenic mass in the lumbar muscle decreased in size after the fifth course of chemotherapy. All symptoms subsequently disappeared after treatment. Conclusion In summary, lumbar metastasis from choriocarcinoma is extremely rare. Appropriate chemotherapy can successfully treat these metastasized tumors.