Virchows Archiv

, Volume 456, Issue 1, pp 65–70 | Cite as

Primary choriocarcinoma of the liver: a clinicopathological study of five cases in males

  • Huaiyin ShiEmail author
  • Dengfeng Cao
  • Lixin Wei
  • Lu Sun
  • Aitao Guo
Original Article


Primary choriocarcinomas of the liver are rare. Previous reported cases were mostly in infants with only rare adult cases. Here, we presented five adult cases. The patients were all males, with an average age of 41.6 years (from 36 to 48 years). Clinical presentations included right upper abdominal pain or abdominal distension. All patients presented with a large hepatic mass on ultrasonography that measured 11 cm on average in the greatest diameter. Elevated serum human chorionic gonadotropin (HCG) levels were noted in all cases. At presentation, the tumor was confined to the liver in two patients and therefore surgically resected. The other three patients presented with extrahepatic metastases on imaging study and therefore only received chemotherapy. All five patients died from the tumor within 2 to 8 months. Autopsy was performed for all five cases. The autopsy confirmed that the choriocarcinoma was confined to the liver in two surgically resected cases. The other three patients had metastatic choriocarcinoma in the lung (two patients), peritoneum (one patient), adrenal glands (one patient), and brain (one patient). None of the patients had any evidence of a testicular tumor or scar after examination of the entirely submitted testes. No tumor was observed in central nervous system, mediastinum, or other organs other than described above. Grossly, the primary tumors were large, soft, hemorrhagic, and with foci of necrosis. Histologically, the tumors were composed of mononucleated trophoblastic cells with round nuclei, clear cytoplasm, and prominent nucleoli admixed with large, multinucleated syncytiotrophoblastic cells. Immunohistochemically, tumor cells were strongly positive for keratin, HCG, and focally positive for human placental lactogen. Ki-67 proliferation index was high (mean 75%) in the mononucleated trophoblastic cells. Our series is the largest one to document primary hepatic choriocarcinoma in adults. Although these tumors are rare, they behave in a very aggressive fashion.


Choriocarcinoma Extragonadal germ cell tumors Liver 



The author thanks Xin Song, Wei Chen, Enping Bai, Shiming Zan, Chao Guo, and Xia Tian for their excellent technical assistance.

Conflict of interest statement

We declare that we have no conflict of interest.


  1. 1.
    Moran CA, Suster S (1997) Primary mediastinal choriocarcinomas: a clinicopathologic and immunohistochemical study of eight cases. Am J Surg Pathol 21:1007–1012CrossRefPubMedGoogle Scholar
  2. 2.
    Greenwood SM, Goodman JR, Schneider G et al (1971) Choriocarcinoma in a man. Am J Med 51:416–422CrossRefPubMedGoogle Scholar
  3. 3.
    Arai M, Oka K, Nihei T et al (2001) Primary hepatic choriocarcinoma—a case report. Hepatogastroenterology 48:424–426PubMedGoogle Scholar
  4. 4.
    Fernández Alonso J, Sáez C et al (1992) Primary pure choriocarcinoma of the liver. Pathol Res Pract 188:375–377PubMedGoogle Scholar
  5. 5.
    van der Hoef M, Niggli FK, Willi UV et al (2004) Solitary infantile choriocarcinoma of the liver: MRI findings. Pediatr Radiol 34:820–823CrossRefPubMedGoogle Scholar
  6. 6.
    Theegarten D, Reinacher A, Graeven U et al (1998) Mixed malignant germ cell tumour of the liver. Virchows Arch 433:93–96CrossRefPubMedGoogle Scholar
  7. 7.
    Candes FP, Ajinkya MS (1987) Primary mediastinal choriocarcinoma (case report). J Postgrad Med 33:219–221PubMedGoogle Scholar
  8. 8.
    Yamashita S, Ohyama C, Nakagawa H et al (2002) Primary choriocarcinoma in the posterior mediastinum. J Urol 167:1789CrossRefPubMedGoogle Scholar
  9. 9.
    McKenney JK, Heerema-McKenney A, Rouse RV (2007) Extragonadal germ cell tumors: a review with emphasis on pathologic features, clinical prognostic variables, and differential diagnostic considerations. Adv Anat Pathol 14:69–92CrossRefPubMedGoogle Scholar
  10. 10.
    Vegh GL, Szigetvári I, Soltesz I et al (2008) Primary pulmonary choriocarcinoma: a case report. J Reprod Med 53:369–372PubMedGoogle Scholar
  11. 11.
    Bell DM, Porras G, Tortoledo ME et al (2009) Primary sinonasal choriocarcinoma. Ann Diagn Pathol 13:96–100CrossRefPubMedGoogle Scholar
  12. 12.
    Minei S, Matsui T, Obinata D et al (2008) Primary choriocarcinoma of the urinary bladder. Hinyokika Kiyo 54:293–296PubMedGoogle Scholar
  13. 13.
    Kobayashi A, Hasebe T, Endo Y et al (2005) Primary gastric choriocarcinoma: two case reports and a pooled analysis of 53 cases. Gastric Cancer 8:178–185CrossRefPubMedGoogle Scholar
  14. 14.
    Yun EJ, Chung JY, Han HS (2005) Primary mediastinal choriocarcinoma. Int J Gynaecol Obstet 88:158–159CrossRefPubMedGoogle Scholar
  15. 15.
    Dehner LP (1990) Germ cell tumors of the mediastinum. Semin Diagn Pathol 7:266–284PubMedGoogle Scholar
  16. 16.
    Dulmet EM, Macchiarini P, Suc B et al (1993) Germ cell tumors of the mediastinum. Cancer 72:1894–1901CrossRefPubMedGoogle Scholar
  17. 17.
    Lack EE, Weinstein HJ, Welch KJ (1985) Mediastinal germ cell tumors in childhood: a clinical and pathological study of 21 cases. J Thorac Cardiovasc Surg 89:826–835PubMedGoogle Scholar
  18. 18.
    Sato K, Takeuchi H, Kubota T (2009) Pathology of intracranial germ cell tumors. Prog Neurol Surg 23:59–75CrossRefPubMedGoogle Scholar
  19. 19.
    Ragam A, Apichai S, Radhakrishnan A et al (2008) Extragonadal choriocarcinoma in ulcerative colitis. J Clin Oncol 26:5813–5814CrossRefPubMedGoogle Scholar
  20. 20.
    Kathuria S, Jablokov VR (1987) Primary choriocarcinoma of liver with immunohistochemical study and review of the literature. J Surg Oncol 34:39–42CrossRefPubMedGoogle Scholar
  21. 21.
    Kersh RC, Constable WC, Hahn SS et al (1990) Primary malignant extragonadal germ cell tumors: an analysis of the effect of radiotherapy. Cancer 65:2681–2685CrossRefPubMedGoogle Scholar
  22. 22.
    Jacobsen GK, Barlebo H, Olsen J et al (1984) Testicular germ cell tumours in Denmark 1976–1980. Pathology of 1058 consecutive cases. Acta Radiol Oncol 23:239–247CrossRefGoogle Scholar
  23. 23.
    Powell S, Hendry WF, Peckham MJ (1983) Occult germ-cell testicular tumours. Br J Urol 55:440–444CrossRefPubMedGoogle Scholar
  24. 24.
    Yoon JM, Burns RC, Malogolowkin MH et al (2007) Treatment of infantile choriocarcinoma of the liver. Pediatr Blood Cancer 49:99–102CrossRefPubMedGoogle Scholar
  25. 25.
    Balzer BL, Ulbright TM (2006) Spontaneous regression of testicular germ cell tumors: an analysis of 42 cases. Am J Surg Pathol 30:858–865CrossRefPubMedGoogle Scholar
  26. 26.
    Wong NA, D'Costa H, Barry RE et al (1998) Primary yolk sac tumour of the liver in adulthood. J Clin Pathol 51:939–940CrossRefPubMedGoogle Scholar
  27. 27.
    Lenci I, Tariciotti L, Baiocchi L et al (2008) Primary yolk sac tumor of the liver: incidental finding in a patient transplanted for hepatocellular carcinoma. Transpl Int 21:598–601CrossRefPubMedGoogle Scholar
  28. 28.
    Toumi N, Chaumette-Plankaert MT, Cherqui D et al (2004) Germ cell tumors. Case 3. Primary yolk sac tumor of the liver. J Clin Oncol 22:1756–1758CrossRefPubMedGoogle Scholar
  29. 29.
    Verma M, Agarwal S, Mohta A (2003) Primary mixed germ cell tumour of the liver—a case report. Indian J Pathol Microbiol 46:658–659PubMedGoogle Scholar
  30. 30.
    Kim SN, Chi JG, Kim YW et al (1993) Neonatal choriocarcinoma of liver. Pediatr Pathol 13:723–730CrossRefPubMedGoogle Scholar
  31. 31.
    Verbeek W, Schulten HJ, Sperling M et al (2004) Rectal adenocarcinoma with choriocarcinomatous differentiation: clinical and genetic aspects. Hum Pathol 35:1427–1430CrossRefPubMedGoogle Scholar
  32. 32.
    Granier G, Marty-Double C (2007) Gastrointestinal adenocarcinomas with a choriocarcinomatous component: 2 cases and a review of 120 cases in the literature. Gastroenterol Clin Biol 31:854–857PubMedCrossRefGoogle Scholar
  33. 33.
    Yamamoto S, Tanaka H, Takeo H et al (2006) Primary pulmonary choriocarcinoma combined with adenocarcinoma. Pathol Int 56:402–407CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Huaiyin Shi
    • 1
    Email author
  • Dengfeng Cao
    • 2
  • Lixin Wei
    • 1
  • Lu Sun
    • 1
  • Aitao Guo
    • 1
  1. 1.Department of PathologyThe Chinese PLA General HospitalBeijingChina
  2. 2.Department of Pathology and Immunology, School of MedicineWashington UniversitySaint LouisUSA

Personalised recommendations