Seungeun Lee; Ji Yun Jeong; Joungho Han; Chang Ohk Sung; Yong Soo Choi

doi:10.6058/jlc.2011.10.1.44

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Lee, Jeong, Han, Sung, and Choi: Pulmonary Carcinoma with β-Human Chorionic Gonado-tropin Expression: Further Understanding and Suggestions for This Entity from Six Cases Experience in a Single Insti-tution

Original Article

J Lung Cancer 2011;10(1):44-48.

Published online: 11 January 2011

DOI: https://doi.org/10.6058/jlc.2011.10.1.44

Pulmonary Carcinoma with β-Human Chorionic Gonado-tropin Expression: Further Understanding and Suggestions for This Entity from Six Cases Experience in a Single Insti-tution

Seungeun Lee, M.D.¹, Ji Yun Jeong, M.D.¹, Joungho Han, M.D., Ph.D.¹, Chang Ohk Sung, M.D.¹, Yong Soo Choi, M.D., Ph.D.²

¹Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

²Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Address for correspondence Joungho Han, M.D., Ph.D. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon- dong, Gangnam-gu, Seoul 135-710, Korea Tel: 82-2-3410-2800 Fax: 82-2-3410-0025 E-mail: hanjho@skku.edu

Revised 2 May 20111 June 2011 Accepted 13 June 2011

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

Purpose:

β-human chorionic gonadotropin (β-hCG) expressing pulmonary carcinoma is very rare, and little is known about this entity. The aim of this study was to find the characteristic clinicopathologic features of β-hCG expressing pulmonary carcinoma. Materials and Methods: Of all 2790 lobec-tomy specimens of lung excised between January 2006 and December 2010, only six cases of β-hCG expressing pulmonary carcinoma were identified retrospectively. The cases were classified according to the WHO classification, and clinicopathologic features were investigated.

Results:

The patients consisted of 4 males and 2 females, and the median age was 64 years. Half of the patients presented with blood tinged sputum or hemoptysis. The median tumor diameter was 4.2 cm. All but one case showed prominent area of hemorrhage and necrosis. All six cases were pleomorphic carcinoma, composed of various types of non-small cell carcinomatous component and giant cell component. All cases showed significant area of β-hCG positivity, and β-hCG was usually expressed in the pleomorphic giant cells.

Conclusion:

In pulmonary carcinoma with pleomorphic giant cells, is necessary to check immunohistochemical stain for β-hCG and to follow up the serum β-hCG levels, to further establish the concept of β-hCG expressing pulmonary carcinoma.

Keywords: Pleomorphic carcinoma, Lung, Human chorionic gonadotropin

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Fig. 1.

Representative pathologic features of β-hCG expressing pulmonary carcinoma. (A) Gross photography shows a large necrotic mass. (B) Scanning view reveals extensive hemorrhage (hematoxylin-eosin stain, ×1). (C) The tumor was composed of poorly differentiated large tumor cells with pleomorphic giant cells (hematoxylin-eosin stain, ×200). The tumor cells are negative for p63 (inset) (ABC method, ×100). (D) The giant cell component shows marked pleomorphism with occasional multinucleation, which are similar morphology to syncytiotrophoblast (hematoxylin-eosin stain, ×400). (E) Immunohistochemical stains for β-hCG shows intense cytoplasmic positive in pleomorphic giant cells (ABC method, ×400).

Table 1.

Clinical Findings of 6 Cases of β-hCG Expressing Pulmonary Carcinoma

Case	Sex/ Age	Smoking (PY)	Chief complaint	Site	Size (cm)	pT	pN	Stage	ETE	Adjvant	Follow up duration (mo)	Status
1	M/73	30	Dyspnea	RUL	4.5	T2	N0	Ib	−	No	7	NED
2	M/60	No	Blood tinged sputum	RUL	9.5	T3	N0	IIb	−	CTX	1	DOD
3	M/68	45	Chest discomfort	RUL	2	T1	N1	IIa	＋	No	2	DOD
4	M/78	15	Blood tinged sputum	RUL	5	T2	N0	Ib	＋	No	15	NED
5	F/51	No	Hemoptysis	RLL	4	T2	N0	Ib	−	CTX	16	AWD
6	F/34	No	Abnormal Chest x-ray	RLL	2	T1	N0	Ia	−	No	14	NED

AWD: alive with disease, CTx: chemotherapy, DOD: dead of disease, ETE: endolymphatic tumor emboli, NED: no evidence of disease, PY: pack years, RLL: right lower lobe, RUL: right upper lobe.

Table 2.

Pathologic Findings in 6 Cases of β-hCG-Expressing Pulmonary Carcinoma

Cases	Macroscopic finding	Microscopic finding
		Viable tumor		Hemorrhage & necrosis
		Amount (%)	Cell type (%)	Amount (%)
1	Hemorrhage and necrosis	40	Large cell: 20	60
			Giant cell: 80
2	Hemorrhage and necrosis	10	Large cell: 65	90
			Giant cell: 30
3	Solid (with necrosis)	90	Adeno: 70	5
			Giant cell: 30
4	Hemorrhage and necrosis	10	Adenosquamous: 20	90
			Giant cell: 80
5	Hemorrhage and necrosis	20	Large cell: 60	80
			Giant cell: 40
6	Hemorrhage and necrosis	40	Large cell: 50	60
			Giant cell: 50

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