A 30-year-old man presented with
cough and bloody sputum. He brought a chest radiogram showing abnormal findings. His chest computed tomography revealed a large mediastinal mass and multiple nodular shadows in both lungs. The serum beta-HCG level was remarkably elevated, and physical examination revealed bilateral
gynecomastia and right supraclavicular lymph node swelling. His lymph node was biopsied and
choriocarcinoma was diagnosed. After 3 cycles of BEP
therapy (
cisplatin,
etoposide,
bleomycin), the
tumors regressed and the serum beta-HCG level decreased. Although there were
residual tumors and serum beta-HCG was mildly elevated, he refused additional
therapy. The
choriocarcinoma progessed rapidly again and he died seven months after his first visit. Primary mediastinal
germ cell tumors are rare, and in particular the pure type of
choriocarcinoma arising in the mediastinum is even rarer. Patients with mediastinal
choriocarcinoma are mostly young men. The prognosis of primary mediastinal
choriocarcinoma is still very poor despite the introduction of combination chemotheraphy including
cisplatin. We report a case of primary mediastinum pure
choriocarcinoma.
Chemotherapy was effective for the patient, but he died because of recurrence after refusal of future treatment. Establishment of more effective treatment is necessary.