Twin Tumor of the Esophagus—Extensive Choriocarcinoma with Adenocarcinoma

Introduction: Primary gastrointestinal (GI) choriocarcinoma is rare. In GI, primary gastric choriocarcinoma is the most common, with 0.08% of stomach malignant tumors. After 1970 only 20 case reports of esophageal choriocarcinoma have been reported in the literature. We are adding to this small collection an interesting case of nongestational choriocarcinoma arising from a lower esophagus with adenocarcinoma.

Case: A case of 59-year-old male with Type II diabetes mellitus and hypertension, no addiction, history of carcinoma pancreas to mother and ECOG PS-I presented with early satiety, postprandial fullness, and constipation for 1 year. On examination, mild pallor was present, and systemic examinations were within normal limits. Routine blood investigations showed microcytic anemia (Hb: 9.6 g/dL, mean corpuscular volume: 72 fL), and renal function test and liver function test were within normal limits. For evaluation of anemia, upper GI endoscopy was done which showed large fungating growth at lower esophagus ([Fig. 1]). Colonoscopy was normal. Biopsy of esophageal lesion was suggestive of poorly differentiated carcinoma ([Fig. 1B]). Immunohistochemistry (IHC) showed CK 7, Beta HCG, Cdx 2 positive suggestive of extensive choriocarcinoma component ([Fig. 1C]), microsatellite stable MMS/MMR proficient with Pdl 1 expression (CPS > 10%). To rule out gestational choriocarcinoma, USG (ultrasonography) scrotum was done which showed no abnormality, normal AFP, and high beta HCG (627,118 mIU/mL). Positron emission tomography-computed tomography showed an ametabolic esophageal lesion in right lateral wall of lower esophagus without extramural extension with locoregional lymph node and multiple liver ametabolic lesions suggestive of metastasis. We plan to do a liver biopsy and IHC to decide systemic chemotherapy regimen.

Conclusion: We encountered a very rare aggressive tumor of primary lower esophageal choriocarcinoma with adenocarcinoma with liver and lymph node metastasis having no established chemotherapy protocols. Precise pathology examination is required to diagnose such a rare disease.

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Publication History

Article published online:
22 April 2024