case_images: PMC10838210_01
case_images: (a) A computed tomographic scan of the chest showing the 3 pulmonary masses with the largest mass located posteriorly in the right lower lobe. (b) MRI of the brain (T2-weighted axial image) showing the solitary brain metastasis consisting of a 2.7 cm nodular component with perilesional edema and hemorrhagic characteristics: susceptibility artifacts with foci of signal loss on T2-gradient echo sequence in the peripheral part of the nodule. (c, d) 18F-FDG PET/CT showing FDG avidity and extent of the bilateral pulmonary tumoral sites with physiologic uptake in the urinary tract.
case_images: CRIONM2024-8731806.001.jpg
case_images: PMC10838210_01_CRIONM2024-8731806.001.jpg
case_images: fig1
case_images: A computed tomography (CT) scan of the thorax, abdomen, and pelvis was performed which disclosed bilateral pulmonary masses (n = 3) arising from the lung parenchyma with the greatest mass measuring 12 cm in the right lower lobe (Figure 1).
case_images: Histologic and IHC findings. (a) Malignant tumor with extensive necrosis, mostly composed of large tumor cells with enlarged hyperchromatic nuclei and eosinophilic to clear cytoplasm (hematoxylin and eosin stain, x20). (b) HCG is immunopositive in the cytoplasm of tumor cells (x20). (c) SALL-4 is positive in the nucleus of most tumor cells (x20). (d) GATA-3 is firmly nucleus positive in mononuclear trophoblast cells (x20). (e) P40 are nucleus positive in mononuclear trophoblast cells (x20). (f) CK pan is diffused and strongly positive in the cytoplasm of tumor cells (x20). (g) TTF-1 IHC is negative in the tumor cells (x20). (h) D2-40 is negative in the tumor cells (x20). HCG: human chorionic gonadotropin; GATA-3: anti-GATA3 antibody; CK pan: pankeratin; TTF-1: thyroid transcription factor 1.
case_images: CRIONM2024-8731806.002.jpg
case_images: PMC10838210_01_CRIONM2024-8731806.002.jpg
case_images: fig2
case_images: Microscopic pathological result is malignant with extensive tumor necrosis (Figure 2).
case_images: Human chorionic gonadotropin (HCG) levels. Day 0 represents the start of the chemoimmunotherapy.
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case_images: PMC10838210_01_CRIONM2024-8731806.003.jpg
case_images: fig3
case_images: His beta-hCG decreased to normal values 3 months after the initiation of chemoimmunotherapy (Figure 3).