Published online Dec 28, 2013. doi: 10.3748/wjg.v19.i48.9485
Revised: November 5, 2013
Accepted: November 12, 2013
Published online: December 28, 2013
Processing time: 148 Days and 15.5 Hours
We report a case of hepatic choriocarcinoma in a man diagnosed at autopsy after a rapid downhill clinical course. The patient was a 49-year-old man who presented with acute right-sided abdominal pain. There were no masses palpable on physical examination. Radiographic findings showed large multi-nodular tumors mainly in the right lobe of the liver. Fludeoxyglucose-positron emission tomography scan showed uptake only in the liver, and no uptake in the testes. We initially planned to perform a liver resection for the presumed diagnosis of intra-hepatic cholangiocarcinoma. However, the tumors grew rapidly and ruptured. Multiple lung metastases rapidly developed resulting in respiratory failure, preventing liver resection or even biopsy. He died 60 d after initial presentation with no pathological diagnosis. Postmortem studies included histopathological and immunohistological examinations which diagnosed a primary choriocarcinoma of the liver. Primary hepatic choriocarcinoma is very rare but should be considered in the differential diagnosis of a liver tumor in a middle aged man. Establishing this diagnosis may enable treatment of the choriocarcinoma. Liver biopsy and evaluation of serum human chorionic gonadotropin are recommended in these patients.
Core tip: Evaluation of serum human chorionic gonadotropin levels in addition to other liver tumor markers should be performed in middle-aged men with undiagnosed hepatic tumors, to rule-out the possibility of primary hepatic choriocarcinoma. Liver biopsy is important to diagnose this rare and highly malignant tumor.