Primary Adenocarcinoma with Focal Choriocarcinomatous Differentiation in the Sigmoid Colon

Sook Kyoung Oh; Hyung Wook Kim; Dae Hwan Kang; Cheol Woong Choi; Yu Yi Choi; Hong Kyu Lim; Ja Jun Goo; Sung Yeol Choi

doi:10.4166/kjg.2015.66.5.291

Journal List > Korean J Gastroenterol > v.66(5) > 1007446

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Oh, Kim, Kang, Choi, Choi, Lim, Goo, and Choi: Primary Adenocarcinoma with Focal Choriocarcinomatous Differentiation in the Sigmoid Colon

Case Report

Korean J Gastroenterol 2015;66(5):291-296.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.66.5.291

Primary Adenocarcinoma with Focal Choriocarcinomatous Differentiation in the Sigmoid Colon

Sook Kyoung Oh, Hyung Wook Kim, Dae Hwan Kang, Cheol Woong Choi, Yu Yi Choi, Hong Kyu Lim, Ja Jun Goo, Sung Yeol Choi¹

Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

¹Department of Internal Medicine, Wallace Memorial Baptist Hospital, Pusan, Korea

Correspondence to: Hyung Wook Kim, Department of Internal Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea. Tel: +82-55-360-1534, Fax: +82-55-360-1536, E-mail: mdkhwook@gmail.com

Received 20 April 2015 Revised 15 June 2015 Accepted 15 July 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Adenocarcinoma, Choriocarcinoma, Colon, Drug therapy

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Fig. 1.

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

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).

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).

Table 1.

Clinical Features of Colorectal Choriocarcinoma through Literature Review

Case	Sex/Age (yr)	Primary colon tumor location c	Primary colon tumor histology	Metastatic tumor location	Metastatic tumor histology	Serum beta-hCG (mIU/mL)	Treatment	Survival (mo)
Park¹ 1980	F/49	Sigmoid	A＋ C	Liver, lung	C	Not checked	Palliative resection	4
Nguyen² 1982	M/74	Sigmoid	A＋ C	Liver	C	400-before op	Laparotomy	3
Ordóñez³ 1984	F/35	Ascending	A＋ C	Liver, lung	C	1,612-after op	Right hemicolectomy	2
Kubosawa⁴ 1984	F/50	Sigmoid	A＋ C	Liver, lung	C	230,000-before op	Hartmann's procedure	4
Metz⁵ 1985	F/42	Sigmoid	A＋ C	Liver, lung, spleen	C	154,000	Laparotomy	1
Lind⁶ 1986	M/42	Ascending	C	Liver, lung, spleen	C	610,000	Palliative resection	1
Ostör⁷ 1993	F/28	Rectum	A＋ C	Liver	C	16,500-before op	Anterial resection, EMA/CO	1
Tokisue⁸1996	F/29	Rectum	A＋ C	Lung, brain, vagina	Not checked	49,000-before CTx	EMA, anterial resection, EMA＋ cisplatin＋ doxo-rubicin	10
Oh⁹1997	M/69	Sigmoid	A＋ C	Liver, lung, thyroid brain, hyphopharynx	C	78-after op	Colectomy, MTX＋ vincristine＋ VP16＋ leukovorin	15
Kim¹⁰1997	M/59	Cecum	A＋ C	Not checked	Not checked	Not checked	Not checked	Not checked
Kiran¹¹2001	M/68	Rectum	A＋ C	Liver	Not checked	700,000	Hartmann's procedure	Not checked
Le¹²2003	M/73	Ascending Descending	C	Lung, brain, kidney, pancreas	Not checked	146,000	No	15 days
Verbeek¹³2004	F/54	Rectum	A＋ C	Liver, lung	Not checked	6,831-after op	Palliative resection, cisplatin＋ etoposide＋ ifosfamide	8
Jeong¹⁴2007	M/52	Rectum	A＋ C	Liver, lung	Not checked	4,224-after op	Low anterial resection, bleomycin＋ etoposide ＋cisplatin	47days
Froylich¹⁵2010	F/57	Descending	C	Lung, bone, brain	C	13,000-after op	Colectomy, VP16＋ ifosfamide＋ cisplatin	16
Harada¹⁶2012	F/58	Sigmoid	A＋ C	No	No	2,420-before op	Hartmann's procedure, EMA, UFT/leucovorin	60
Jiang¹⁷2013	M/38	Ascending	C	Liver	Not checked	10,000-after op	Colectomy, bleomycin＋ etoposide＋ cisplatin	6
Maehira¹⁸2013	M/68	Sigmoid	A＋ C	Liver	Not checked	1.4 ng/mL-after op	Sigmoidectomy, FOLFOX, FOLFIRI＋ bevacizumab	9
Mardi¹⁹2014	F/54	Rectum	A＋ C	No	No	4,568	Radical resection, 5-FU, leucovorin	50 days
Present case	F/61	Sigmoid	A＋ C	Liver	Not checked	35	FOLFIRI＋ bevacizumab, FOLFOX	13

beta-hCG, beta-human chorionic gonadotropin; A, adenocarcinoma; C, choriocarcinoma; op, operation; EMA/CO, etoposide, methotrexate, and actinomycin D, alternating with cyclophosphamide and vincristine; CTx, chemotherapy; MTX, methotrexate; VP16, etoposide; UFT, tegafur-uracil.

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