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Case Report
 
Primary mediastinal choriocarcinoma in a male patient: A case report
Ayman A. Rasmy1, Waleed M. Selwi1, Samir T. Fotih1, Ehab A. Hassan1, Usama H. Ismail2
1Assistant Consultant, Adult Oncology Department, King Fahad Specialist Hospital, Dammam, KSA.
2Assistant Consultant Cardiology, King Fahad Specialist Hospital, Dammam, KSA.

Article ID: 100001Z10AR2015
doi:10.5348/Z10-2015-1-CR-1

Address correspondence to:
Dr. Ayman Ahmed Rasmy
Adult Oncology Department, Oncology Center
King Fahad Specialist Hospital( KFSH-D), Al Murekbat Area
Omar Bin Thabet Street, Dammam
Saudi Arabia; Postal Code Box: 15215, ZIP Code: 31444
Phone: 00966541899333
Fax: 0096638442222 (Ext.6854)

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How to cite this article:
Rasmy AA, Selwi WM, Fotih ST, Hassan EA, Ismail UH. Primary mediastinal choriocarcinoma in a male patient: A case report. J Case Rep Images Oncology 2015;1:1–4.


Abstract
Introduction: Choriocarcinoma is a malignant germ cell neoplasm. It can exhibit in a gonadal site or, rarely, in extra-gonadal sites. Primary mediastinal choriocarcinoma can occur in both male and female in second and third decades of their life, but it is more common in male. The most common symptoms are cough, chest pain and gynecomastia. Plasma chorionic gonadotrophin (β-hCG), which is used as a tumor marker for diagnosis, staging and monitoring of the treatment response. Chemotherapy can achieve response if the case diagnosed early and receive the proper treatment earlier. BEP regimen is the standard first line chemotherapy, unless there is no contraindication specially for the presence of lung disease (Bleomycin) or kidney disease (cisplatin).
Case Report: We describe here a case of a 22-year-old heavy smoker Saudi male for more than 10 years, who was referred to us as a case of advanced pulmonary choriocarcinoma which confirmed by pathology and tumor marker. Our patient was admitted to ICU initially due to shortness of breath. The diagnosis was confirmed as a case of primary mediastinal choriocarcinoma. It could not be treated by surgery due to bad general condition of the patient with severe difficulty in breating requiring respiratory support and ICU care. The chemotherapy was started by VeIP Protocol for one cycle but due to no subjective response as well as the presence of same high level β-hCG, the chemotherapy was changed to TIP Protocol. On the last day of chemotherapy, the patient started to complain about increasing tachypnea and tachycardia. He was transfered to ICU and was was intubated there. Although there was a significant decrease in his β-hCG level, but unfortunately the patient died with multi-organ failure.
Conclusion: Early diagnosis of germ cell tumor can increase the chance of cure. The presence of primary disease in different extra-gonadal sites like primary medicinal choriocarcinoma that leads to delay in the diagnosis, which reflected on the treatment outcome with poor overall prognosis even with the presence of different chemotherapy protocols.

Keywords: Choriocarcinoma, Extra gonadal Choriocarcinoma, Primary Mediastinal Choriocarcinoma, TIP protocol, VeIP protocol


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Author Contributions
Ayman A. Rasmy – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Waleed M. Selwi – Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Samir T. Fotih – Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Ehab A. Hassan – Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Usama H. Ismail – Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Ayman A. Rasmy et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.