Primary Mediastinal Choriocarcinoma

Primary extragenital choriocarcinoma is a rare tumor. Magovern and Blades in 1958 (1) collected 25 cases from the literature, of which 11 were situated in the mediastinum (Table I). The case to be reported in this article is believed to be the twelfth.3 The rarity of this tumor stimulated a survey of the literature and 7 cases reported in the English language were reviewed in the effort to discover some conclusions regarding etiology, diagnosis, therapy, and prognosis. Case Report J. W., a 26-year-old white married truck driver, was first seen in the Outpatient Department of the University of California at Los Angeles Medical Center on July 29, 1955, with a chief complaint of right-sided chest pain of four months duration. It has first come to his attention in April, subsequent to a minor motorcycle accident and the strain of lifting a bathtub onto a truck, both injuries being considered trivial. The pain was situated in the third intercostal space just to the right of the sternum, was rather severe for two to three weeks, and then gradually disappeared. Recurrence one week later was accompanied by pain in the right shoulder and in the back of the neck. There had been one episode of paresthesia involving the right hand and lower lip. Heat treatments had been administered by two physicians whom he had consulted, without results. A chest roentgenogram obtained in a doctor's office demonstrated an abnormal density in the right thorax. This was interpreted as an aortic aneurysm. While the patient had had contact with potential syphilitic carriers, his spinal fluid and blood serology were negative. A chest film made a year earlier was reported normal. Initial physical examination revealed a well developed, well nourished white male in no distress. A few nontender nodes were present in the cervical, axillary, and inguinal areas. The liver was palpable two fingerbreadths below the right costal margin and the spleen was questionably palpable. There was left rib margin tenderness, but the chest examination was otherwise negative. There was no gynecomastia. Chest films obtained Aug. 3 (Figs. 1 and 2) showed a well demarcated anterior mediastinal mass. This was interpreted as a cyst, possibly an intrathoracic extension of a reduplication of the foregut. The patient was now complaining of dyspnea and neck pain. He was scheduled for admission and exploration but these were cancelled because a cold developed. A repeat roentgenogram on Sept. 6 (Fig. 3) revealed the mass to have doubled in size since the previous examination, and lymphosarcoma and malignant thymoma were now considered the best diagnostic possibilities. The patient had had several bouts of hemoptysis in the preceding three weeks and at this time complained of exertional dyspnea, orthopnea, malaise, and a 20-1b. weight loss in the past three months. A left axillary lymph-node biopsy on Sept. 12 showed the nodes to be benign.