Primary Pulmonary Choriocarcinoma In A Male:a Case Report And Literature Review

Objective: To explore the clinical characteristics of primary pulmonary choriocarcinoma(PPC)in males,in order to deepen the understanding of the disease.Methods: Retrospective analysis the clinical data of a case of male primary pulmonary choriocarcinoma in the first affiliated hospital of Guangxi Medical University in 2019,and summarize its clinical characteristics by reviewing the domestic and international literature.Results: The patient was a middle-aged male with an onset age of 37 years.The patient presented with acute pancreatitis in May 2019.During hospitalization,he was found to have a nodular shadow of about 2.5 × 2.0 cm in the apical segment of the left upper lobe due to abdominal pain,with multiple occupying spaces in the liver and pancreas,serum β-HCG: 50.77ug/L.In June2019,a wedge resection of the left lower lobe of the lung achieved by thoracoscopic surgery.Pathology: mixed lung cancer,the cancer consists of choriocarcinoma(80%)and adenocarcinoma(20%).Immunohistochemistry results: adenocarcinoma: CK7(+),part EGFR(+),Ki-67×2(+,about 10%),Napsin A(+),P63(+).Choriocarcinoma: part CK7(+),part EGFR(+),Ki-67×2(+,about 90%),part P63(+),HCG(+).And rule out the possibility of primary choriocarcinoma in other parts,the final diagnosis was:1.primary choriocarcinoma of the left lung stage Ⅳ,with multiple metastases from liver and pancreas;2.left pulmonary adenocarcinoma.The patient started chemotherapy in July 2019 with EMA/CO regimen.After 2 cycles of chemotherapy,the condition improved,but the disease progressed after 5 cycles of chemotherapy.Replacement of TP/TE second-line chemotherapy for 1 cycle,the treatment effect is still poor.Replace third-line TIP regimen 2 cycles of chemotherapy,however,the condition has progressed significantly than before,switch to thalidomide and capecitabine regimen chemotherapy for 1 cycle,patients with liver metastasis rupture bleeding,so decided to use GN regimen rescue chemotherapy 1 cycle and and he was treated with PD-1 once,and the condition became worse one week after discharge and died on March 22,2020.Literature review results: Using the keywords "primary,choriocarcinoma,lung,and men",we searched the literature from 1970 to 2020 through China knowledge Network,Wanfang,and Pubmed databases.A total of 31 articles of male primary pulmonary choriocarcinoma that met the requirements were retrieved.A total of 36 cases were reported at home and abroad,and all cases were confirmed by pathological examination.Among the 36 male patients,the age of onset was 4 months to 77 years,the median age was 56.5 years,and the average age was 52.4 years.The main clinical symptoms were hemoptysis,cough,sputum,chest pain,and dyspnea.A few may have breast swelling,testicular atrophy,precocious puberty,etc.Twenty-six patients(72.2%)had distant metastases.Common metastases were in the lung,brain,lymph nodes,and liver.Twenty-seven patients were tested for serum β-HCG or urine HCG,and 24(88.8%)were positive.The chest imaging of 33 patients showed pulmonary nodules or masses,5 cases(15.2%)were multiple nodules and masses of different sizes,and 28 cases(84.8%)were mainly single masses or nodules.The pathological manifestations were composed of cytotrophoblast cells and syneytiotrophoblast cells,often accompanied by necrosis and hemorrhage,and immunohistochemical HCG positive expression,ten patients(27.8%)had other types of tumors at the same time.Treatment includes surgery,radiation therapy,chemotherapy,or combination therapy.Of the 36 patients,a total of 27 patients died,accounting for 75%.The course of disease was 3 days to 3 years,and the median survival time was 5 months.Conclusions:(1)Primary lung choriocarcinoma is very rare in men.It is more common in elderly men and is invasive and prone to hematogenous metastasis.(2)Common clinical manifestations are hemoptysis,cough,sputum,chest pain,and dyspnea.If there are specific manifestations of breast feminization,testicular atrophy,and loss of libido,timely detection of blood or urine HCG is important for the early diagnosis of the disease and is available.It is used to monitor the therapeutic effect and evaluate the prognosis.(3)Chest imaging is mainly manifested as a single nodule or mass in the lung,and a few are multiple nodules or masses of varying sizes.(4)The diagnosis depends on pathology,choriocarcinoma is composed of cytotrophoblast and syncytiotrophoblast,often accompanied by hemorrhage and necrosis.It has strong positive expression of HCG in immunohistochemistry,and at the same time merges with other types of malignant tumors.(5)The disease is highly malignant,progresses rapidly,and has a very poor prognosis.There is currently no standard treatment.