J Breast Cancer.  2013 Sep;16(3):349-353. 10.4048/jbc.2013.16.3.349.

Breast Carcinoma with Choriocarcinomatous Features: A Case Report

• Sung HJ
• Maeng YI
• Kim MK
• Lee SJ
• Kang SM
• Bong JG
• Oh HK

• KMID: 2286389
• DOI: http://doi.org/10.4048/jbc.2013.16.3.349

Abstract

Nongestational choriocarcinoma differentiation is extremely rare in breast neoplasms. It is characterized by tumor cells similar to chorionic trophoblastic cells, which react with human placental lactogen and human chorionic gonadotropin (hCG). A 56-year-old woman presented with a palpable right breast mass without past history of trophoblastic tumors. An F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan revealed one focus with low accumulation of FDG in the right breast (maximum standardized uptake value, 1.98). The patient underwent a right mastectomy and biopsy of sentinel nodes. Microscopically, the tumor was a typical invasive ductal carcinoma with multiple foci of choriocarcinoma features. Immunohistochemistry showed that the tumor cells resembling choriocarcinoma were positive for hCG antibody, but negative for HER2/neu, estrogen receptor, and progesterone receptor. A pathologic diagnosis of breast carcinoma with choriocarcinomatous features was made. To our knowledge, this is the first report of invasive carcinoma with choriocarcinomatous features and an unusual finding of low accumulation in an F-18 FDG PET/CT scan in Korea.

Keyword

Breast neoplasms; Choriocarcinoma; Human chorionic gonadotropin

MeSH Terms

Biopsy
Breast
Breast Neoplasms
Carcinoma, Ductal
Choriocarcinoma
Chorion
Chorionic Gonadotropin
Electrons
Estrogens
Female
Humans
Immunohistochemistry
Korea
Mastectomy
Middle Aged
Nitriles
Placental Lactogen
Pregnancy
Pyrethrins
Receptors, Progesterone
Trophoblastic Neoplasms
Trophoblasts
Chorionic Gonadotropin
Estrogens
Nitriles
Placental Lactogen
Pyrethrins
Receptors, Progesterone

Figure

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  Figure 1 Breast imagings. (A) Mammography shows ill-defined lobulating and spiculated mass with microcalcification, classified as category 4. (B) Ultrasonography shows about 3×18 mm lobulating hypoechoic mass in 10 o'clock direction of the right breast.

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  Figure 2 F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography shows a soft tissue mass lesion with low FDG accumulation with maximum standardized uptake value 1.98 in the right breast (arrow) without other hypermetabolic lesion in whole body.

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  Figure 3 Gross finding. It shows relatively well-defined grayish mass with irregular margins.

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  Figure 4 Characteristic microscopic findings. The carcinoma with choriocarcinomatous features show high nucleus/cytoplasm ratio, increased nuclear chromatin and multinucleated giant cells resembling syncytiotrophoblasts (H&E stain, ×40 and ×200 in inlet compartment, left picture). Immunohistochemical stain shows some tumor cells positive for human chorionic gonadotropin antibody (×200 in inlet compartment, right picture).

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