SHM Converge Scientific Abstract ePoster Gallery-A Rare Occurence of Extragonadal Choriocarcinoma in the Lung

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This case report describes a rare <strong>extragonadal choriocarcinoma presenting as a lung mass</strong> in a 54-year-old woman. Germ cell tumors are usually found in the gonads, but can rarely occur outside them, most often in the mediastinum or retroperitoneum. In this patient, the tumor appeared in the <strong>right lower lobe of the lung</strong>, an unusual location that initially raised concern for primary lung cancer or lymphoma.

The patient had a history of heavy tobacco use and presented with <strong>2 months of worsening shortness of breath and cough</strong>, along with prior hemoptysis, weight loss, orthopnea, and diaphoresis. On exam, she was in respiratory distress with severe hypoxia. Chest imaging showed a <strong>large 18 cm right lower lobe mass</strong> with mediastinal and supraclavicular lymphadenopathy and significant compression of nearby structures. Laboratory studies showed <strong>elevated tumor markers</strong> including <strong>β-hCG, CA-125, and LDH</strong>, which suggested a possible germ cell tumor. Diagnosis was confirmed by <strong>endobronchial biopsy</strong> two weeks after admission, revealing <strong>choriocarcinoma</strong>.

She was started on <strong>VIP chemotherapy</strong> (etoposide, ifosfamide, cisplatin) and treated for suspected post-obstructive pneumonia. However, her condition worsened during hospitalization, progressing to <strong>multi-organ failure</strong> and kidney injury requiring consideration of dialysis. Due to her poor prognosis, the family chose comfort-focused care, and she died shortly after extubation.

The report emphasizes that clinicians should <strong>not rule out germ cell tumors simply because a patient has had a hysterectomy or lacks a pelvic mass</strong>. It also notes that choriocarcinoma can be highly aggressive, and tumors with <strong>sarcomatoid components</strong> may respond poorly to chemotherapy. More research is needed to improve treatment for extragonadal germ cell tumors.

Asset Subtitle

Devesh Kumar

Meta Tag

Author List Amer Al Homssi, Breanna Palmen, Devesh Kumar, Hamsitha Karra

Category Clinical Vignettes

Concept Extragonadal Germ Cell Tumor

Concept Choriocarcinoma

Concept Beta-hCG

Concept Lung Mass

Concept Mediastinal Mass

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Devesh Kumar

Track Adult

Keywords

extragonadal choriocarcinoma

lung mass

right lower lobe

germ cell tumor

beta-hCG

VIP chemotherapy

endobronchial biopsy

mediastinal lymphadenopathy

multi-organ failure

sarcomatoid components

Extragonadal Germ Cell Tumor

Choriocarcinoma

Beta-hCG

Lung Mass

Mediastinal Mass