Journal List > J Lung Cancer > v.10(1) > 1050628

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

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.

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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).
jlc-10-44f1.tif
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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