title: Incidental primary mediastinal choriocarcinoma diagnosed by endobronchial ultrasound-guided fine needle aspiration in a patient presenting with transient ischemic attack and stroke.
abstract: We describe a case of a 41-year old male patient with no significant prior medical history who presents with symptoms of Transient Ischemic Attack and stroke. Magnetic Resonance Imaging (MRI) of the brain identified areas of ischemia in the left side, and angiography showed occlusion of the left Medial Cerebral Artery (MCA). Cardiac Transthoracic Echocardiogram (TTE) for stroke evaluation incidentally noted a mediastinal abnormality leading to cancer work-up. Computer Tomography (CT) and18F-fluorodeoxyglucose (FDG) PET-CT scan of the chest incidentally revealed an avid 6 cm paraesophagial/subcarinal mass. Further diagnostic work-up with endoscopic and endobronchial ultra sound (EBUS)-guided fine needle aspiration (FNA) of the mass yielded a cytology diagnosis of Germ Cell Tumor (GCT), with choriocarcinoma component. Additionally, high plasma levels of β-human chorionic gonadotrophin (β-HCG) were detected with no evidence of testicular tumor. This exceedingly rare presentation for a primary mediastinal choriocarcinoma underscores the importance of complete investigation of young patients presenting with neurological symptoms compatible with ischemic events. Diagn. Cytopathol. 2017;45:738-743. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Ivo M B
authors.identifier: http://orcid.org/0000-0002-5764-5454
authors.initials: IMB
authors.lastname: Francischetti
authors.affiliation: Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.|Division of Cytology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cajigas
authors.affiliation: Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.|Division of Cytology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Mark
authors.initials: M
authors.lastname: Suhrland
authors.affiliation: Department of NeuroRadiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Joaquim M
authors.initials: JM
authors.lastname: Farinhas
authors.affiliation: Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.|Division of Cytology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Samer
authors.initials: S
authors.lastname: Khader
mesh_terms: D000328:Adult; D031954:Choriocarcinoma, Non-gestational / Q000150:complications / Q000000981:diagnostic imaging*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D033162:Incidental Findings; D002546:Ischemic Attack, Transient / Q000150:complications / Q000175:diagnosis; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D020521:Stroke / Q000150:complications / Q000175:diagnosis
keywords: choriocarcinoma; germ cell tumor; incidental findings