CHORIOCARCINOMA OF BREAST: A RARE ENTITY
J. Aleem ,A. Mumtaz , N. Iqbal , A. Rehman
Shaukat khanum memorial cancer hospital and research center, radiology, Lahore, Pakistan.
ABSTRACT
Breast lump is becoming more common
for last few years. Among these lumps
metastasis to breast is rare. Extra-
gestational choriocarcinoma is extremely
rare among breast neoplasms. We intent
to present a case of 30 years old woman
with breast mass and axillary
lymphadenopathy with history of treated
uterine trophoblastic tumour. To our
knowledge, this is the first report of
invasive carcinoma of breast with
choriocarcinomas features and an
unusual finding at an unusual site.
Patient underwent breast mass and
axillary lymph node ultrasound guided
true cut core biopsy and FDG-PET scan for
staging. No local disease recurrence at
vaginal stump but relapse in breast and
axilla only.
METHODS
Single case will be included who was
diagnosed with choriocarcinoma of uterus
in 2019. She underwent TAH+ unilateral
right salpingo-oophorectomy at outside
hospital in 2019 and received
chemotherapy at Shaukat khanum hospital
Lahore. Now she ultrasound guided true
cut core biopsy at Shaukat khanum
hospital Lahore . FDG -PET scan was also
performed.
INTRODUCTION:
Breast is unusual site of extra gestational
choriocarcinoma. There are two varieties
of breast choriocarcinoma: metastatic and
breast cancer with choriocarcinoma
features. Breast choriocarcinoma presents
with well circumscribed mass without
spiculations, architectural distortion and
calcifications. They may be predominantly
solid or has some cystic component. In this
case report, the history, physical
examination, laboratory findings, imaging
studies, and pathological findings of
metastatic breast choriocarcinoma in a 30-
year-old woman are described. Most of
the literatures is about breast carcinoma
with choriocarcinoma features.
SHAUKAT KHANUM MEMORIAL
CANCER HOSPITAL & RESEARCH CENTRE
Figure 1, grey scale and dopplar ultrasound images.
Heterogenous infiltrative hypoechoic solid mass with cystic
foci diffusely involving whole right breast central and outer
quadrants. No vascularity on dopplar.
Figure 2, A and B axial 18 FDG PET scan images
showing 18-FDG avid right breast mass with ipsilateral
avid axillary lymphadenopathy.
REFERENCES
1. Breast Carcinoma with Choriocarcinomatous
Features: A Case Report
Hyun-Jung Sung, Young-In Maeng, Min-Kyung
Kim, Sun-Jae Lee, Sung-Min Kang, Jin-Gu Bong,
Hoon-Kyu Oh,
1Department of Pathology, Catholic University
of Daegu School of Medicine, Daegu.
2. Department of Pathology, Goodsamaritan
Hospital, Pohang; Departments of Nuclear
Medicine and Breast and Thyroid Surgery,
Catholic University of Daegu School of
Medicine, Daegu, Korea. J Breast Cancer 2013
September; 16(3): 349-353.
2. Breast Carcinoma with Choriocarcinomatous
Features
Dr. Amrisha Jaiswal1, Dr. Parul Gupta, Dr.
Nirupma Lal, Dr. Nida Parveen,Junior resident
Department of Pathology, ELMCH
Associate Professor Department of Pathology,
ELMCH Professor Department of Pathology,
ELMCH.
3. Metastatic Choriocarcinoma to the Breast:
Appearance on Mammography and Doppler
Sonography Naveen Kalra1, Vijayanadh Ojili1,
Madhu Gulati1, G. R. V. Prasad2, Kim Vaiphei3,
Sudha Suri1
7-A Block R III, Johar Town, Lahore, Pakistan
DISCUSSION
Breast choriocarcinoma is further
divided into two varieties , metastatic
breast choriocarcinoma or breast
carcinoma with choriocarcinomatous
differentiation and both are extremely
rare varieties. Second mentioned
variety was first described in 1981 by
Saigo and Rosen in 55 year old woman
1.
Metastatic breast choriocarcinoma is
labelled when there is history of
gestational throphoblastic disease or
choriocarcinoma. Non- gestational
choriocarcinomatous differentiation
has been described arising in many
organ including urinary bladder,
stomach, and colon. Breast carcinoma
with choriocarcinomatous features is
reported in literature had palpable
lumps in right breast with axillary
lymphadenopathy. On histology most
of patients had invasive ductal
carcinoma with choriocarcinomatous
component at periphery. In some
common breast tumor cases serum
beta-HCG levels are also monitored . It
has also been observed that 12% to
60% of patients with breast carcinoma
reveal weak tumor immunostaining for
subunits of HCG too. The exact
pathophysiology and
immunohistochemistry of HCG
expression in common breast tumours
is still uncertain. But high levels of
serum beta -HCG and presence of beta-
HCG antibodies are extremely
uncommon in usual breast carcinomas.
This feature differentiate between
presence of metastasis or breast
carcinoma with carcinomatous
differentiations 2,3.
Metastatic breast choriocarcinoma
shares common radiological features
with usual breast neoplasms. It may
present with high density mass with
obscured margins on mammogram
without spiculations and calcifications.
On ultrasound it shows mixed solid and
cystic echotexture due to tendency of
internal haemorrhage. PET scan is
mandatory in these cases for
management to rule out multi-organ
disease 3.
Most of the reported cases in literature
had poor prognosis , therefore, prompt
diagnosis and early management is
necessary. Most cases of breast
carcinoma with choriocarcinoma
features have aggressive clinical course.
Complete excision and thorough
pathological examination is mandatory
for correct diagnosis.
Metastatic breast choriocarcinoma is
extremely aggrerate 3.
ssive and metastasize early but
respond well to chemotherapy.
Therefore, early diagnosis and
management improves survival.
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