Pulmonary Pathology Online
Pathology of Germ Cell Tumours of the Lung
Both benign and malignant, can arise within the lung. They are more often benign than malignant, although malignant lesions may have a favorable postoperative prognosis and benign lesions may exhibit high morbidity and mortality because of their size and location.
Site: This large, cystic tumours show a predilection for left upper lobe.
Clinical presentation: Cough, hemoptysis, chest pain, and occasionally with expectoration of hairs.
They occur equally in men and women and usually are diagnosed in the second to fourth decade of life. These tumors present radiographically as lobulated masses that may contain calcification or peripheral collections of air.
Histologic features are identical to those of teratomas arising in gonads.
Rarely, primary choriocarcinoma of the lung have been reported. Human chorionic gonadotrophin (hCG) is a useful marker for chorionic proliferative disorders, such as choriocarcinoma.
Although hCG synthesis in lung cancers is frequent, primary pulmonary choriocarcinoma is rare.
Primary pulmonary choriocarcinoma arises from epithelial cells which may undergo metaplasia or divergent differentiation.
Such differentiation may occur in visceral carcinomas as a focal change, and rarely as the sole pathway of tumor differentiation in extragonadal organs, where it has been termed primary choriocarcinoma or giant cell carcinoma with ectopic human chorionic gonadotropin production.
Differential diagnosis: Differences between primary pulmonary choriocarcinoma (PCC) and hCG-producing giant cell carcinoma (GCC) of the lung.
Microscopically, both types of tumours mainly consisted of atypical polygonal cells.While primary pulmonary choriocarcinoma (PCC) contained many syncytial trophoblast-like multinucleated cells that had strong immunoreactivity for anti-hCG, such cells were relatively few in hCG-producing giant cell carcinoma (GCC).
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