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A 27-year-old man with primary mediastinal choriocarcinoma was reported. He was admitted with complaint of right chest pain and dyspnea. Chest X-ray film and computed tomography of the chest revealed a bulky mass at anterior mediastinum and right pleural effusion. Physical examination revealed bilateral gynecomastia, and the serum beta-HCG level was cap at 500 ng/ml. The specimens obtained by percutaneous needle biopsy of the mediastinal mass showed cytotrophoblasts and syncytiotrophoblasts. He received 4 cycles of anti-cancer chemotherapy, and underwent resection for a residual mass, in which viable cancer cells remained in histological examination. In spite of additional chemotherapy, multiple lung metastasis developed rapidly. High dose chemotherapy, with carboplatine (200 mg/m2 x 4 days), etoposide (250 mg/m2 x 4 days) and cyclophosphamide (50 mg/kg x 2 days) was performed in combination with peripheral blood stem cell autotransplantation. However, brain metastasis set in and he died of respiratory failure 9 months after the onset of symptoms.
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