Extragonadal
non-gestational choriocarcinoma is a rare but well-described phenomenon occurring in patients with midline
germ cell tumors.
Choriocarcinoma (ChC) is an aggressive
neoplasm usually developing in women as a rare complication of pregnancy. In male patients ChC occurs in the testes, usually as a component of mixed
germ cell tumors. Very few patients develop extragonadal
choriocarcinoma with the
tumor occurring in midline locations, such as the mediastinum, retroperitoneum, and central nervous system (mostly pineal gland). Non-midline
choriocarcinoma can occur in the lung, gastrointestinal tract, and breast, sometimes blended with another primary
malignancy. A midline
choriocarcinoma manifesting as a head and neck
malignancy is exceptional. During an evaluation of multiple enlarged cervical lymph nodes suspected to be
lymphoma in a 72-year-old man, a core biopsy was taken from one of the left neck lymph nodes which histologically showed a necrotic
malignancy with strong diffuse pancytokeratin staining. After an initial interpretation of metastatic
carcinoma, further samples were taken from both tonsils and from a right level 5 neck lymph node. Histologically, all samples contained the same
tumor, showing profound pleomorphism and multinucleated syncytial-type giant cells. A panel of immunohistochemistry studies were performed, including β-
human chorionic gonadotropin, with positive findings leading to a diagnosis of extragonadal
non-gestational choriocarcinoma.