Korean J Gastroenterol.  2015 Nov;66(5):291-296. 10.4166/kjg.2015.66.5.291.

Primary Adenocarcinoma with Focal Choriocarcinomatous Differentiation in the Sigmoid Colon

• Oh SK
• Kim HW
• Kang DH
• Choi CW
• Choi YY
• Lim HK
• Goo JJ
• Choi SY

• KMID: 2373360
• DOI: http://doi.org/10.4166/kjg.2015.66.5.291

Abstract

Primary colorectal choriocarcinoma is a rare neoplasm. Only 19 cases have been reported worldwide, most of which involved adenocarcinomas. The prognosis is usually poor, and the standard therapy for this tumor has not been established. A 61-year-old woman presented with constipation and lower abdominal discomfort. She was diagnosed with primary adenocarcinoma with focal choriocarcinomatous differentiation in the sigmoid colon and liver metastasis. Because the serum beta-human chorionic gonadotropin level was not significantly elevated, and because only focal choriocarcinomatous differentiation was diagnosed, we selected the chemotherapy regimen that is used for the treatment of metastatic colorectal adenocarcinoma. The patient survived for 13 months after the initial diagnosis. This is the first case in Korea to assess the suppressive effects of the standard chemotherapy for colorectal adenocarcinoma against coexisting colorectal choriocarcinoma and adenocarcinoma.

Keyword

Adenocarcinoma; Choriocarcinoma; Colon; Drug therapy

MeSH Terms

Adenocarcinoma/*diagnosis/drug therapy/pathology
Antineoplastic Agents/administration & dosage
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
CA-19-9 Antigen/analysis
Chorionic Gonadotropin, beta Subunit, Human/blood
Colon, Sigmoid/pathology
Colonic Neoplasms/*diagnosis/drug therapy/pathology
Colonoscopy
Constipation/etiology
Female
Fluorouracil/therapeutic use
Humans
Leucovorin/therapeutic use
Liver Neoplasms/secondary
Middle Aged
Organoplatinum Compounds/therapeutic use
Prognosis
Tomography, X-Ray Computed
Antineoplastic Agents
CA-19-9 Antigen
Chorionic Gonadotropin, beta Subunit, Human
Organoplatinum Compounds
Leucovorin
Fluorouracil

Figure

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  Fig. 1. Colonoscopic finding. Ulceroinfiltrating mass in the sigmoid colon (initial diagnosis).

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  Fig. 2. Abdominal CT findings. (A, B) Multiple liver metastasis with focal wall thickening of sigmoid colon (initial diagnosis). (C, D) Interval decrease in the size of liver metastasis and sigmoid colon cancer (after 4 months of FOLFIRI with bevacizumab chemotherapy: partial response). (E, F) Interval increase in the size of liver metastasis and sigmoid colon (after 9 months of FOLFIRI with bevacizumab chemotherapy: progressive disease).

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  Fig. 3. Pathologic findings of the sigmoid colon biopsy. (A) Moderately differentiated adenocarcinoma is along with syncytiotrophoblastic giant cells giant cells (H&E, ×200). (B) Anaplastic tumor cells have eosinophilic abundant cytoplasm with hyperchromatic and pleomorphic nuclei, forming giant cells (H&E, ×200). (C) These anaplastic tumor cells show cytoplasmic positivity for beta-human chorionic gonadotropin staining (immunohistochemical staining, ×200).

Reference

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