Indian Journal of Pathology and Microbiology

CASE REPORT
Year
: 2012  |  Volume : 55  |  Issue : 3  |  Page : 406--408

Cutaneous metastasis of testicular choriocarcinoma, diagnosed by fine-needle aspiration cytology: A rare case report and review of the literature


Bita Geramizadeh1, Hanieh Rad2,  
1 Transplant Research Center, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran

Correspondence Address:
Bita Geramizadeh
Department of Pathology, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, PO BOX: 71345-1864
Iran

Abstract

Skin metastasis of testicular choriocarcinoma is very rare. Until now about nine cases have been reported in the English literature; however, only one of them has been diagnosed by fine-needle aspiration (FNA) cytology. Herein, we report our experience with FNA cytology diagnosis of a metastatic testicular choriocarcinoma to the skin of chin. The combination of highly atypical mononuclear cells (cytotrophoblasts) and multinucleated malignant cells (syncytiotrophoblasts) are characteristic of metastatic tumor in a known case of choriocarcinoma of testis.



How to cite this article:
Geramizadeh B, Rad H. Cutaneous metastasis of testicular choriocarcinoma, diagnosed by fine-needle aspiration cytology: A rare case report and review of the literature.Indian J Pathol Microbiol 2012;55:406-408


How to cite this URL:
Geramizadeh B, Rad H. Cutaneous metastasis of testicular choriocarcinoma, diagnosed by fine-needle aspiration cytology: A rare case report and review of the literature. Indian J Pathol Microbiol [serial online] 2012 [cited 2019 Oct 23 ];55:406-408
Available from: http://www.ijpmonline.org/text.asp?2012/55/3/406/101760


Full Text

 Introduction



Choriocarcinoma is a highly malignant tumor with common metastasis to the lung and brain. [1] Skin metastasis of choriocarcinoma is very rare and about 15 cases have been reported in the English literature so far. [2] These cases have been from different sites such as testis, endometrium, retroperitoneum, and ovary. [1],[3] Testicular choriocarcinoma with skin metastasis is exceptional. The diagnosis of metastatic choriocarcinoma by fine-needle aspiration (FNA) has rarely been reported in locations such as breast, vagina or brain but only one of skin metastasis has been reported to be diagnosed by FNA. [4],[5],[6],[7] Diagnosis of metastatic tumors to skin by FNA cytology is very rapid and accurate, especially in the patients with known malignancy. [4],[7] In this case report we present a patient with testicular choriocarcinoma and a metastatic skin nodule which was diagnosed by FNA cytology.

 Case Report



A 26-year-old male referred to the hospital for right testicular enlargement, which after imaging studies turned out to be testicular tumor. With this impression right orchiectomy was done for him. Abdominal and chest computed tomography (CT) scan were normal with no evidence of metastasis.

Beta-human chorionic gonadatropin (HCG) at the time of diagnosis was >150000 IU/ ml (normal <5 IU/ml), but after resection it begins to decrease (5000/2700/1400/500).

Pathologic studies of the testicular tumor showed pure choriocarcinoma. After surgery, chemotherapy was started (bleomycin, cisplatin, etoposide, and dexamethazone). During his first hospital stay for chemotherapy, a small cutaneous nodule was detected in the right side of his chin [Figure 1].{Figure 1}

FNA cytology of the nodule was performed yielded scanty material and the smears stained by Papanucolau (Pap) and Wright methods. Cytology smears showed rich cellularity composed of many tight clusters [Figure 2]a and rare isolated large mononuclear cells with severe atypia, hyperchromatic nuclei, one or multiple distinct nucleoli and plenty of basophilic cytoplasm [Figure 2]b. Some of these large cells showed prominent macronucleoli [Figure 2]c. Some multinucleated large atypical cells were also present.{Figure 2}

With the diagnosis of subcutaneous metastatic choriocarcinoma, the nodule was excised which confirmed the cytological diagnosis [Figure 3].{Figure 3}

Now after a month the patient is well and still continuing the chemotherapeutic regimen.

 Discussion



Skin is an uncommon site for metastatic tumors and overall incidence of cutaneous metastasis of different tumor types is about 1.4-4.4%. [8]

The most frequent tumors with skin metastasis are breast, colon, and melanoma in women and lung, colon and melanoma in men. The most common sites of skin metastasis are chest and abdomen followed by head and neck. [8]

Metastatic testicular choriocarcinoma to the skin has been very rarely reported and to the best of our knowledge about nine cases of metastatic choriocarcinoma with skin metastasis has been reported in the English literature so far [Table 1]. [2],[7],[9],[10],[11],[12],[13],[14],[15],[16],[17] Until now only a case has been reported to be diagnosed by FNA cytology. [7] {Table 1}

Cytologic smears of choriocarcinoma either primary or metastatic are reported to show both cytotrophoblasts and syncytiotrophoblasts. [9],[10] In our case, FNA of the subcutaneous nodule was performed and showed good cellularity with many tight clusters composed of mononuclear cells with large hyperchromatic nuclei and several distinct nucleoli. Rare multinucleated cells were present in the smears

The diagnosis of metastatic choriocarcinoma was made according to the patient's history and also confirmed by histology. However, it would be difficult to diagnose without known primary malignancy and if the smears were composed of predominantly mononuclear cytotrophoblasts. [4],[10] In this situation, any high grade malignant tumor from the more common cancers such as lung and breast could not be excluded without ancillary studies. [4]

There are reports of FNA cytology diagnosis of metastatic germ cell tumors to different sites other than skin such as brain, and mediastinum, but according to previous reports and our experience cytological findings of choriocarcinoma is characteristic i.e., presence of mononucleated cells and multinucleated giant cells corresponding to cytotrophoblasts and syncytiotrophoblasts, respectively, can be diagnostic especially with a positive history. [4] FNA cytology can be very helpful with rapid results for the diagnosis of metastatic skin choriocarcinoma. [7]

Our case is the second report of skin metastasis of choriocarcinoma which was diagnosed by FNA cytology.

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