A patient with primary gastric choriocarcinoma who received a correct preoperative diagnosis and achieved prolonged survival.

Primary choriocarcinoma of the stomach is an extremely rare and highly malignant tumor. A 68-year-old Japanese man was admitted to our department with symptoms of epigastric pain, abdominal fullness, and dizziness. Primary gastric choriocarcinoma with regional lymph node metastases was diagnosed preoperatively by the detection of elevated serum levels of a tumor marker, radiography, and immunohistochemical staining of biopsy specimens. The patient underwent total gastrectomy and jejunal reconstruction (Roux-en-Y method), followed by chemotherapy. Histological examination of the resected stomach revealed typical choriocarcinoma accompanied by common adenocarcinomatous elements. After postoperative chemotherapy the patient survived for 4 years and 6 months, and died with no evidence of recurrence of carcinoma. This is the first known patient with primary gastric choriocarcinoma to have survived for such a long period without recurrent elevation of the serum level of human chorionic gonadotropin (HCG), which was a useful marker when reevaluating the patient.