A RARE CASE OF PRIMARY CHORIOCARCINOMA OF THE MEDIASTINUM

Background. Primary choriocarcinoma of the mediastinum is a rare aggressive malignant germ cell tumor with poor prognosis. The disease predominantly affects young men and is characterized by high metastatic activity.

Case Presentation. We present a case of primary metastatic choriocarcinoma of the mediastinum in a 26-year-old man. The disease manifested with acute onset of cough, dyspnea, fever, and pulmonary hemorrhage. Computed tomography revealed a mediastinal mass measuring 131×60 mm with multiple lung lesions. Serum human chorionic gonadotropin level was 1308.0 mIU/ml. Video-assisted thoracoscopy with atypical resection of the upper lobe of the left lung was performed. The patient died in the postoperative period. Autopsy revealed a mediastinal tumor measuring 7.0×6.0×5.5 cm, dark red in color, with soft-elastic consistency and multiple hemorrhages, with metastases to the lungs, liver, kidneys, spleen, brain, and lymph nodes. Histological examination revealed atypical syncytiotrophoblasts and cytotrophoblasts with high mitotic activity. Immunohistochemical study showed positive staining for PanCK, hCG, Inhibin, p63, Glypican3 and negative for CD30, confirming the diagnosis of choriocarcinoma. Total examination of the testes revealed no pathological changes.

Conclusion. Primary choriocarcinoma of the mediastinum requires early diagnosis based on comprehensive evaluation of clinical, laboratory, and instrumental data, but definitive verification is only possible through morphological examination with a broad panel of immunohistochemical markers. The prognosis remains extremely poor.

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