Pseudostroke as a manifestation of mediastinal choriocarcinoma in an elderly man

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Abstract

We describe a rare clinical case: onset of acute neurological symptoms suggestive of a pesudostroke, caused by an imbalance in cerebral blood flow as a result of internal carotid artery compression by an enlarged lymph node secondary to metastases from a disseminated non-gestational mediastinal choriocarcinoma. This was accompanied by decompensation due to paraneoplastic coagulopathy.

About the authors

Yuliya S. Korneva

Smolensk Regional Institute of Pathology; Smolensk State Medical University

Email: miloserdovmax@mail.ru

Cand. Sci. (Med.), Associate Professor, Department of pathological anatomy; pathologist, Department of clinical pathology No. 2

Russian Federation, Smolensk; Smolensk

Natalya N. Maslova

Smolensk State Medical University

Email: miloserdovmax@mail.ru

D. Sci. (Med.), Professor, Head, Department of neurology and neurosurgery

Russian Federation, Smolensk

Yana A. Rudenko

Smolensk State Medical University

Email: miloserdovmax@mail.ru

resident, Department of pathological anatomy

Russian Federation, Smolensk

Maxim A. Miloserdov

Smolensk State Medical University; Red Cross Emergency Hospital

Author for correspondence.
Email: miloserdovmax@mail.ru

Cand. Sci. (Med.), neurologist, assistant, Department of neurology and neurosurgery

Russian Federation, Smolensk; Smolensk

Oksana A. Shisterova

Smolensk Oncological Dispensary

Email: miloserdovmax@mail.ru

Cand. Sci. (Med.), Head, Department of pathological anatomy

Russian Federation, Smolensk

References

  1. Dardiotis E., Aloizou A.M., Markoula S. et al. Cancer-associated stroke: pathophysiology, detection and management (Review). Int J Oncol. 2019;54(3):779- 796. doi: 10.3892/ijo.2019.4669. PMID: 30628661.
  2. Cyriac S., Sagar T.G., Mahajan V. Choriocarcinoma with arterial and venous thrombosis. Neurol India. 2009;57:505-507. doi: 10.4103/0028-3886.55586. PMID: 19770564.
  3. Qiu Z., Wu Y., Wang Y., Hu C. Male primary mediastinal choriocarcinoma with diffuse metastases: A case report. Medicine (Baltimore). 2019;98(28):e16411. doi: 10.1097/MD.0000000000016411. PMID: 31305456.
  4. SakaneT., Okuda K., Murase T. et al. Mixed-type primary germ cell tumor of the mediastinum in a young adult male with a sudden life threatening condition: a case report. Thorac Cancer. 2020;11(1):166-169. doi: 10.1111/17597714.13231. PMID: 31693305.
  5. Lynch M.J., Blewitt G.L. Choriocarcinoma arising in the male mediastinum. Thorax. 1953;8(2):157-161. doi: 10.1136/thx.8.2.157. PMID: 13077513.
  6. Yurick B.S., Ottoman R.E. Primary mediastinal choriocarcinoma. Radiology. 1960;75(6):901-907. doi: 10.1148/75.6.901. PMID: 13787562.
  7. Cohen B.A., Needle M.A. Primary mediastinal choriocarcinoma in a man. Chest. 1975;67(1):106-8. doi: 10.1378/chest.67.1.106. PMID: 1088117.
  8. Gaude G.S., Patil P., Malur P.R., et al. Primary mediastinal choriocarcinoma. South Asian J Cancer. 2013;2(2):79. doi: 10.4103/2278-330x.110495 . PMID: 24455559.
  9. Rehman T., Hameed A., Beharry N., Du Parcq J., Bano G. An unusual cause of gynaecomastia in a male. Endocrinol Diabetes Metab Case Rep. 2019;2019(1):19- 0060. doi: 10.1530/EDM-19-0060. PMID: 31373476.
  10. Blokh I., Oiseth S. J., Fuks J. et al. Metastatic choriocarcinoma in a middle-aged man presenting as a right thigh mass with venous thrombosis. Med Oncol. 2003;20(2):189-194. doi: 10.1385/mo:20:2:189. PMID: 12835524.
  11. Qiu J., Jia S., Li G. Incidence and prognosis factors of extragonadal choriocarcinoma in males: a population-based study. Cancer Manag Res. 2018;10:4565- 4573. doi: 10.2147/CMAR.S175948. PMID: 30410393.
  12. Jiang F., Xiang Y., Feng F.Z. et al. Clinical analysis of 13 males with primary choriocarcinoma and review of the literature. Onco Targets Ther. 2014;7:1135- 1141. doi: 10.2147/ott.s62561. PMID: 25018640.
  13. Luo M., Peng H., Song M. et al. Primary mediastinal choriocarcinoma: a case report and literature review. Zhong Nan Da XueXueBao Yi Xue Ban. 2017;42(10):1222-1227. doi: 10.11817/j.issn.1672-7347.2017.10.016. PMID: 29093257.
  14. Soussain C., Michel-Langlet P., Mahjoubi M. et al. Brain metastasis of choriocarcinoma in males. Apropos of a case. Review of the literature. Bull Cancer. 1992;79(8):751-757. PMID: 1281698
  15. Kuno I., Matsumoto Y., Kasai M. et al. Primary mediastinal choriocarcinoma with brain metastasis in a female patient. Eur J Gynaecol Oncol. 2016;37(2):265- 266. PMID: 27172760.
  16. Reverdiau P., Jarousseau A.C., Thibault G. et al. Tissue factor activity of syncytiotrophoblast plasma membranes and tumoral trophoblast cells in culture. Thromb Haemost. 1995;73(1):49-54. doi: 10.1055/s-0038-1653724. PMID: 7740495.
  17. Francischetti I.M.B., Cajigas A., Suhrland M. et al. Incidental primary mediastinal choriocarcinoma diagnosed by endobronchial ultrasound-guided fine needle aspiration in a patient presenting with transient ischemic attack and stroke. Diagnostic Cytopathology. 2017;45(8):738-743. doi: 10.1002/dc.23719. PMID: 28397369.
  18. Vilenskiy B.S., Anosov V.V. Insul’t: trudnosti i oshibki pri diagnostike i lechenii. [Stroke: difficulties and errors in diagnosis and treatment]. Leningrad: Medicina, 1980. 272 p. (In Russ.)
  19. Vereshchagin N.V., Morgunov A.A., Gulevskaya T.S. [Pathology of the brain in atherosclerosis and arterial hypertension]. Moscow, 1997. 288 p. (In Russ.)
  20. Dzhunusova K.I., Kamynina I.E., Leykin I.B. et al. Pseudostroke states with clinical presentation of ischemic and hemorrhagic stroke. Vestnik novykh meditsinskikh tekhnologiy. 2010;8(3):215-217. (In Russ.)

Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Microscopic appearance of the anterior mediastinal tumour. Haematoxylin and eosin staining, ×100.

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3. Fig. 2. Appearance typical for germ cell cancer obtained during immunohistochemical study, ×200. А — predominantly membranous placental alkaline phosphatase expression in the mediastinal tumour cells; В — cytoplasmic staining of the mediastinal tumour cells using cytokeratin 7 antibodies; С — no CD30 expression in the mediastinal tumour cells; D — no thyroid transcription factor-1 expression in the mediastinal tumour cells.

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4. Fig. 3. Red thrombi in the right hemisphere microcirculation. Haematoxylin and eosin staining, ×100. 

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Copyright (c) 2021 Korneva Y.S., Maslova N.N., Rudenko Y.A., Miloserdov M.A., Shisterova O.A.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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