Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2019; 7(14): 1837-1843
Published online Jul 26, 2019. doi: 10.12998/wjcc.v7.i14.1837
Primary gastric choriocarcinoma - a rare and aggressive tumor with multilineage differentiation: A case report
Simona Gurzu, Constantin Copotoiu, Alexandra Tugui, Cedric Kwizera, Rita Szodorai, Ioan Jung
Simona Gurzu, Alexandra Tugui, Rita Szodorai, Ioan Jung, Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures 530149, Romania
Simona Gurzu, Research Center (CCAMF), University of Medicine, Pharmacy, Sciences and Technology, Targu Mures 540139, Romania
Constantin Copotoiu, Cedric Kwizera, Department of Surgery, University of Medicine, Pharmacy, Sciences and Technology, Targu Mures 530149, Romania
Author contributions: Gurzu S drafted the article and diagnosed the case; Copotoiu C performed the surgical interventions; Alexandra Tugui contributed to the histological diagnosis and searched literature data; Kwizera C contributed to the surgical intervention and managed clinical data; Szodorai R searched archived data; Jung I contributed to the diagnosis and immunohistochemical assessment and confer the final agreement for publication; Gurzu S and Kwizera C had equally contribution to the paper.
Supported by a grant of the Romanian National Authority for Scientific Research, CNCS – UEFISCDI, No. 20 PCCF/2018, code: PN-III-P4-ID-PCCF-2016-0006.
Informed consent statement: Signed consent of patient was obtained.
Conflict-of-interest statement: The authors deny any conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Simona Gurzu, MD, PhD, Chief Doctor, Full Professor, Consulting Pathologist, Department of Pathology, University of Medicine, Pharmacy, Sciences and Technology, 38 Gheorghe Marinescu Street, Targu Mures 530149, Romania. simona.gurzu@umftgm.ro
Telephone: +40-745-673550Fax: +40-265-210407
Received: February 26, 2019
Peer-review started: February 26, 2019
First decision: April 18, 2019
Revised: May 28, 2019
Accepted: June 10, 2019
Article in press: June 10, 2019
Published online: July 26, 2019
Processing time: 150 Days and 18.6 Hours
Abstract
BACKGROUND

Primary choriocarcinoma of the stomach (PCCS) is a rare tumor, with fewer than 60 cases published in the English-language literature up to December 2018. In this paper, we present the complex immunoprofile of one PCCS and a hypothesis regarding its histogenesis.

CASE SUMMARY

A 66-year-old previously healthy male underwent an emergency palliative gastrectomy for a gastric obstructive tumor. The histologic examination and immunoprofile of tumor cells showed a mixed tumor that consisted of choriocarcinoma (90%) and moderate differentiated adenocarcinoma (10%), with hepatic metastases (Stage pT2NxM1L1V1R0) and microsatelite stable status. The patient died one month after surgery. The tumor cells showed focal positivity for CDX2 (adenocarcinoma component), HCG (choriocarcinoma) and CD138 (plasmacytoid carcinoma component) and were negative for HER-2, α-fetoprotein, VEGF, maspin and markers of epithelial-mesenchymal transition. The gastric mucosa cells displayed positivity for CDX2, Hepar A and CD138. The complex immunoprofile and literature data synthesis prove that the gastric mucosa cells can present a multilineage differentiation.

CONCLUSION

PCCS should be considered as an aggressive variant of microsatellite stable gastric adenocarcinoma of an epithelial type, and not a germ cell tumor.

Keywords: Choriocarcinoma; Stomach; Gastrointestinal; Immunohistochemistry; Maspin; Case report

Core tip: In this paper we presented an extremely rare histological variant of aggressive gastric carcinomas. Few than 60 cases of primary choriocarcinoma of the stomach were published in English literature. The complex immunoprofile of tumor cells, correlated with literature data, showed that gastric mucosa cells can present a multilineage differentiation and choriocarcinoma is a primary microsatellite stable adenocarcinoma without germ cell origins.