Primary nasal-ethmoid choriocarcinoma detected by 18F-FDG PET/CT: a rare tumor with complete remission
, 1, 2, 1, 1
Abstract
Choriocarcinoma is a highly malignant and rare tumor characterized by secretion of the beta-subunit-of-humanchoriogonadotropin (β-HCG). We report a case of primary nasal choriocarcinoma with good response to chemotherapy. A 36-years-old woman gravida 0 and with history of 4 spontaneous abortion, in December 2018 referred to Otorhinolaryngology Department for repeated episodes of epistaxis. Cervical Magnetic Resonance Imaging (MRI) revealed a tumor mass involving right nasal cavity, right ethmoid, sphenoidal and maxillary sinuses. For a differential diagnosis between metastatic gestational choriocarcinoma and primary choriocarcinoma in January 2019 she underwent 18Fluorine-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG-PET/CT) scan that demonstrated intense uptake only in the nasal-ethmoid tumor mass showed by MRI. This was suggestive of primary nasal-ethmoid choriocarcinoma she received 3 courses of BEP – regimen and after β-HCG was reduced to 500 mIU/mL and 18F-FDG-PET/CT scan showed a decreased uptake in tumor mass but the appearance of a new uptake in cervical lymph node which was analysed and reported as metastatic localization of choriocarcinoma. Therefore she was treated with 2 cycles of TIP-regimen. Subsequents 18F-FDG-PET/CT and MRI showed a complete tumor remission. This case proved the fundamental role of PET/CT to make diagnosis of primitive choriocarcinoma and to exclude the hypothesis of distant metastasis.
Keywords: choriocarcinomanasal-ethmoidalPET/CT
References
- Zhou HY, Nguyen JK, Ganesan S, et al. Choriocarcinoma of the adrenal gland: A case report. Int J Surg Case Rep. 2015; 6C: 92–94.
- Gurzu S, Copotoiu C, Tugui A, et al. Primary gastric choriocarcinoma - a rare and aggressive tumor with multilineage differentiation: A case report. World J Clin Cases. 2019; 7(14): 1837–1843.
- Bell DM, Porras G, Tortoledo ME, et al. Primary sinonasal choriocarcinoma. Ann Diagn Pathol. 2009; 13(2): 96–100.
- Tariq M, Kalan A. Metastatic choniocarcinoma of the nasal cavity-presenting as intractable expistaxis. Indian J Otolaryngol Head Neck Surg. 2004; 56(3): 220–222.
- Stockton L, Green E, Kaur B, et al. Non-Gestational Choriocarcinoma with Widespread Metastases Presenting with Type 1 Respiratory Failure in a 39-Year-Old Female: Case Report and Review of the Literature. Case Rep Oncol. 2018; 11(1): 151–158.
- Sato S, Yamamoto E, Niimi K, et al. The efficacy and toxicity of 4-day chemotherapy with methotrexate, etoposide and actinomycin D in patients with choriocarcinoma and high-risk gestational trophoblastic neoplasia. Int J Clin Oncol. 2019.
- Kurobe M, Kawai K, Oikawa T, et al. Paclitaxel, ifosfamide, and cisplatin (TIP) as salvage and consolidation chemotherapy for advanced germ cell tumor. J Cancer Res Clin Oncol. 2015; 141(1): 127–133.
- Motzer RJ, Sheinfeld J, Mazumdar M, et al. Paclitaxel, ifosfamide, and cisplatin second-line therapy for patients with relapsed testicular germ cell cancer. J Clin Oncol. 2000; 18(12): 2413–2418.
