Pembrolizumab for treatment of a male with primary mediastinal choriocarcinoma: a case report.

Primary mediastinal choriocarcinoma is an extremely rare malignant tumor, that is prone to early metastasis and often misdiagnosed. Currently, there is no standardized treatment for primary mediastinal choriocarcinoma. Herein, we report a case to share our experience in the diagnosis and treatment of primary mediastinal choriocarcinoma. A 19-year-old male patient who presented with chest pain and occasional cough for 1 month. He was diagnosed as mediastinal tumor with multiple lung metastases by imaging modalities in a local hospital, and therapeutic surgical excision was performed for the metastasis lesions in lower lobe of right lung. The pathological examination of the surgical specimens supported lung metastasis of choriocarcinoma. Then he was transferred to our hospital for further treatment. Elevated β-human chorionic gonadotropin (β-hCG) serum levels (>200,000 mIU/mL, normal <5 mIU/mL) combined with imaging modalities and pathological consultation of the surgical specimens at admission in our hospital supported the diagnosis of primary mediastinal choriocarcinoma with multiple metastases. During the treatment, we used a variety of treatments, including chemotherapy, radiotherapy and Pembrolizumab. After one cycle of EP chemotherapy (etoposide and cisplatin), computed tomography (CT) scan showed that new nodules appeared in the liver, mass in the anterior mediastinum and part of the nodules in the lungs were enlarged. Pembrolizumab was initiated because of the tumor cells were positive for programmed cell death 1 ligand 1 (PD-L1). The mediastinal mass shrank after two cycles of Pembrolizumab. However, due to the rapid progress of the disease, the patient died of the disease 4 months after the initial symptoms. Advanced primary mediastinal choriocarcinoma is highly aggressive and insensitive to chemotherapy. Pembrolizumab may be used as a salvage treatment for primary mediastinal choriocarcinoma.

Pan W ，Hou J 《-》

Tislelizumab for treatment of a pediatric patient with primary mediastinal choriocarcinoma: a case report.

Primary mediastinal choriocarcinoma (PCC) is a rare, highly vascular invasive, and prognostically unfavorable malignant tumor. When occurring outside the gonads, primary choriocarcinoma is commonly found in midline locations such as the mediastinum or retroperitoneum. Currently, there is no standardized treatment strategy for PCC. In the case reported herein, we employed tislelizumab and chemotherapy in the treatment of a patient with PCC, and as in March 2024, the patient remained survive. A 15-year-old boy who presented with symptoms of fever and cough for a year. Chest computed tomography (CT) scan showed a relatively large soft tissue shadow in the right upper anterior mediastinum, measuring approximately 5.4 cm × 3.8 cm. The patient's soft tissue exhibited unclear demarcation from surrounding mediastinal structures and was accompanied by lung metastasis. The patient underwent a fine needle aspiration biopsy for a mediastinal mass, and the pathology results indicated a germ cell tumor with solid malignant components in the mediastinum, along with pulmonary metastasis of the solid malignancy. The patient's serum levels of beta-human chorionic gonadotropin (β-HCG) were elevated at 125,554 mIU/mL (normal range: <5 mIU/mL), and alpha-fetoprotein (AFP) was 75.8 ng/mL (normal range, 0.605-7 ng/mL). The patient's cranial magnetic resonance imaging (MRI) plain scan indicated multiple scattered abnormal signals in both cerebral hemispheres. Subsequently, the patient was transferred to Children's Hospital of Nanjing Medical University for his further treatment. During the treatment period, we employed various therapeutic approaches, including chemotherapy, radiotherapy and tislelizumab therapy. After five cycles of tislelizumab treatment, the patient's symptoms of cerebral edema significantly improved, β-HCG levels decreased. Brain MRI of the patient revealed multiple abnormal signals within the skull, with some lesions showing reduction in size and significant improvement in the surrounding edema zones. The clinical symptoms of the patient improved and he achieved partial remission (PR). At the moment, the patient is living with the disease. The effectiveness of chemotherapy for PCC is limited. Tislelizumab may potentially serve as salvage treatment options for PCC.

Hu T ，Wu Q ，Li J ，Li T ，Xu J ，Zhou L ... -  《Translational Pediatrics》

A promising treatment option for refractory male primary choriocarcinoma: report of two cases.

Male primary choriocarcinoma is a rare and invasive malignant neoplasm for which traditional chemotherapy has limited efficacy. Pembrolizumab is a humanized monoclonal anti-programmed death-1 antibody that has antitumor activity in numerous malignancies. The diagnosis and treatment of two cases of advanced male primary choriocarcinoma were retrospectively analyzed and relevant literature was reviewed to discuss the prognosis and the efficacy of different treatments, including pembrolizumab. The first patient, who presented with cough and hemoptysis, was diagnosed with primary mediastinal choriocarcinoma. He initially responded to the first-line chemotherapy of etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine, but eventually developed brain metastases. The patient did not respond to the second-line chemotherapy comprising paclitaxel and cisplatin, and he died 6.5 months after diagnosis. The second patient experienced repeated episodes of abdominal pain and was diagnosed with primary neck choriocarcinoma. He received chemotherapy regimens similar to those of the first patient. However, imaging showed no significant changes and his clinical symptoms were not improved. Immunohistochemistry showed that the expression of programmed death ligand 1 on the tumor cells was 40%, and he was administered pembrolizumab combined with chemotherapy. He achieved complete response and was subsequently switched to pembrolizumab maintenance monotherapy. He is still alive without evidence of disease 36 months after diagnosis. To our knowledge, this is the first case of advanced male primary choriocarcinoma successfully treated with pembrolizumab combined with chemotherapy. Advanced male primary choriocarcinoma is highly aggressive and insensitive to chemotherapy. Pembrolizumab may provide a promising treatment option to improve patient outcomes.

Han C ，Zhou Y ，Ma JA ，Liu J ，Jiang YN ，Zhang HX ... -  《-》

[A case of primary mediastinal choriocarcinoma].

Yamane T ，Egawa H ，Deguchi N ，Moritani C ... -  《-》

Male primary mediastinal choriocarcinoma with diffuse metastases: A case report.

Qiu Z ，Wu Y ，Wang Y ，Hu C ... -  《-》