Primary Pulmonary Choriocarcinoma Presenting with Pulmonary Embolism and Hypomagnessemia-Induced Arrhythmia: A Rare and Diagnostically Challenging Case

Iyamu Collins Osaro; Okugbo Stanley Ukadike; Obanovwe Efemena

doi:doi:10.11648/j.ijcts.20261205.13

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| Peer-Reviewed

Primary Pulmonary Choriocarcinoma Presenting with Pulmonary Embolism and Hypomagnessemia-Induced Arrhythmia: A Rare and Diagnostically Challenging Case

Iyamu Collins Osaro^*

, Okugbo Stanley Ukadike

, Obanovwe Efemena

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 12, Issue 5)

Received: 29 August 2026 Accepted: 15 September 2026 Published: 29 September 2026

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Abstract

Background: Choriocarcinoma is a germ cell tumour with highly malignant clinical behaviour. Its non-gestational, or primary subtype is associated with a poor prognosis and marked angioinvasiveness. Primary pulmonary choriocarcinoma (PPC) is exceedingly rare malignancy with no clinical guidelines developed for its treatment and the data on its symptomatology and optimal management remain limited. We report a 37-year-old woman who presented with sudden onset right-sided chest pain, dyspnoea, and cough. Computed tomography scan of the chest demonstrated a right-sided lung mass, and an initial percutaneous needle biopsy suggested a poorly differentiated lung carcinoma. She underwent right pneumonectomy, and postoperative histology of the resected mass confirmed pulmonary choriocarcinoma. While awaiting chemotherapy, she developed clinical features of pulmonary embolism and a malignant arrhythmia that markedly worsened her prognosis despite treatment. A dramatic clinical turnaround was experienced following intravenous magnesium sulphate correction of an incidentally detected hypomagnesemia. She commenced the etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen with a suboptimal response, and was subsequently transitioned to bleomycin, etoposide and cisplatin (BEP), on which she demonstrated marked clinical improvement. This case illustrates the diagnostic difficulty inherent in the evaluation of patients with primary pulmonary choriocarcinoma thus emphasizing the need to consider this rare entity in cases of lung masses, the central role of surgical resection within a multidisciplinary treatment strategy, and the often under-recognized contribution of hypomagnesemia to cardiovascular instability in critically ill oncology patients.

Published in	International Journal of Cardiovascular and Thoracic Surgery (Volume 12, Issue 5)
DOI	10.11648/j.ijcts.20261205.13
Page(s)	131-135
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Primary Pulmonary Choriocarcinoma, Pneumonectomy, Pulmonary Embolism, Hypomagnesemia, Beta Human Chorionic Gonadotropin, Case Report

References

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[6]	Cao X, Feng H, Liu S, Chen L. Analysis of clinical characteristics and prognosis of 68 patients with primary pulmonary choriocarcinoma. BMC Pulm Med. 2023; 23(1): 75 https://doi.org/10.1186/s12890-023-02368-w
[7]	Yeting Zeng, Huibin Zhang, Ningyu Pan, Xuzhou Wang, Lijuan Qu, Baoqing Xu, Xianzong Ye. Clinicopathological features of primary pulmonary choriocarcinoma in males: A report of two cases and literature review j. rmcr, 62(2026) 102360; https://doi.org/10.1016/j.rmcr.2025.102369
[8]	Wang P, Ren D, Guo C, Ding X, Cao Y, Zhao P, Wang Q, Xu W. A rare case of pulmonary artery embolism with choriocarcinoma: A case report and literature review. Oncol Lett. 2023 Sep 28; 26(5): 490. https://doi.org/10.3892/ol.2023.14077
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[12]	Xiaojing Liang, Guoqing Xu, Jisong Zhang, Li Xu, Liangliang Don, Xiaoyue Wang, Weidong Han Enguo Chen; Combination chemotherapy with sintilimab for treatment of male patient with primary pulmonary choriocarcinoma: a case report and literature review; Front Immunol 2025 Jan 23: 16: 1523316 https://doi.org/10.3389/fimmu.2025.1523316
[13]	Severino P, Netti L, Mariani MV, Maraone A, D'Amato A, Scarpati R, Infusino F, Pucci M, Lavalle C, Maestrini V, Mancone M, Fedele F. Prevention of Cardiovascular Disease: Screening for Magnesium Deficiency. Cardiol Res Pract. 2019 May 2; 2019: 4874921. https://doi.org/10.1155/2019/4874921
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APA Style

Osaro, I. C., Ukadike, O. S., Efemena, O. (2026). Primary Pulmonary Choriocarcinoma Presenting with Pulmonary Embolism and Hypomagnessemia-Induced Arrhythmia: A Rare and Diagnostically Challenging Case. International Journal of Cardiovascular and Thoracic Surgery, 12(5), 131-135. https://doi.org/10.11648/j.ijcts.20261205.13

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ACS Style

Osaro, I. C.; Ukadike, O. S.; Efemena, O. Primary Pulmonary Choriocarcinoma Presenting with Pulmonary Embolism and Hypomagnessemia-Induced Arrhythmia: A Rare and Diagnostically Challenging Case. Int. J. Cardiovasc. Thorac. Surg. 2026, 12(5), 131-135. doi: 10.11648/j.ijcts.20261205.13

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AMA Style

Osaro IC, Ukadike OS, Efemena O. Primary Pulmonary Choriocarcinoma Presenting with Pulmonary Embolism and Hypomagnessemia-Induced Arrhythmia: A Rare and Diagnostically Challenging Case. Int J Cardiovasc Thorac Surg. 2026;12(5):131-135. doi: 10.11648/j.ijcts.20261205.13

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@article{10.11648/j.ijcts.20261205.13,
  author = {Iyamu Collins Osaro and Okugbo Stanley Ukadike and Obanovwe Efemena},
  title = {Primary Pulmonary Choriocarcinoma Presenting with Pulmonary Embolism and Hypomagnessemia-Induced Arrhythmia: A Rare and Diagnostically Challenging Case},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {12},
  number = {5},
  pages = {131-135},
  doi = {10.11648/j.ijcts.20261205.13},
  url = {https://doi.org/10.11648/j.ijcts.20261205.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20261205.13},
  abstract = {Background: Choriocarcinoma is a germ cell tumour with highly malignant clinical behaviour. Its non-gestational, or primary subtype is associated with a poor prognosis and marked angioinvasiveness. Primary pulmonary choriocarcinoma (PPC) is exceedingly rare malignancy with no clinical guidelines developed for its treatment and the data on its symptomatology and optimal management remain limited. We report a 37-year-old woman who presented with sudden onset right-sided chest pain, dyspnoea, and cough. Computed tomography scan of the chest demonstrated a right-sided lung mass, and an initial percutaneous needle biopsy suggested a poorly differentiated lung carcinoma. She underwent right pneumonectomy, and postoperative histology of the resected mass confirmed pulmonary choriocarcinoma. While awaiting chemotherapy, she developed clinical features of pulmonary embolism and a malignant arrhythmia that markedly worsened her prognosis despite treatment. A dramatic clinical turnaround was experienced following intravenous magnesium sulphate correction of an incidentally detected hypomagnesemia. She commenced the etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen with a suboptimal response, and was subsequently transitioned to bleomycin, etoposide and cisplatin (BEP), on which she demonstrated marked clinical improvement. This case illustrates the diagnostic difficulty inherent in the evaluation of patients with primary pulmonary choriocarcinoma thus emphasizing the need to consider this rare entity in cases of lung masses, the central role of surgical resection within a multidisciplinary treatment strategy, and the often under-recognized contribution of hypomagnesemia to cardiovascular instability in critically ill oncology patients.},
 year = {2026}
}

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TY  - JOUR
T1  - Primary Pulmonary Choriocarcinoma Presenting with Pulmonary Embolism and Hypomagnessemia-Induced Arrhythmia: A Rare and Diagnostically Challenging Case
AU  - Iyamu Collins Osaro
AU  - Okugbo Stanley Ukadike
AU  - Obanovwe Efemena
Y1  - 2026/09/29
PY  - 2026
N1  - https://doi.org/10.11648/j.ijcts.20261205.13
DO  - 10.11648/j.ijcts.20261205.13
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 131
EP  - 135
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20261205.13
AB  - Background: Choriocarcinoma is a germ cell tumour with highly malignant clinical behaviour. Its non-gestational, or primary subtype is associated with a poor prognosis and marked angioinvasiveness. Primary pulmonary choriocarcinoma (PPC) is exceedingly rare malignancy with no clinical guidelines developed for its treatment and the data on its symptomatology and optimal management remain limited. We report a 37-year-old woman who presented with sudden onset right-sided chest pain, dyspnoea, and cough. Computed tomography scan of the chest demonstrated a right-sided lung mass, and an initial percutaneous needle biopsy suggested a poorly differentiated lung carcinoma. She underwent right pneumonectomy, and postoperative histology of the resected mass confirmed pulmonary choriocarcinoma. While awaiting chemotherapy, she developed clinical features of pulmonary embolism and a malignant arrhythmia that markedly worsened her prognosis despite treatment. A dramatic clinical turnaround was experienced following intravenous magnesium sulphate correction of an incidentally detected hypomagnesemia. She commenced the etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen with a suboptimal response, and was subsequently transitioned to bleomycin, etoposide and cisplatin (BEP), on which she demonstrated marked clinical improvement. This case illustrates the diagnostic difficulty inherent in the evaluation of patients with primary pulmonary choriocarcinoma thus emphasizing the need to consider this rare entity in cases of lung masses, the central role of surgical resection within a multidisciplinary treatment strategy, and the often under-recognized contribution of hypomagnesemia to cardiovascular instability in critically ill oncology patients.
VL  - 12
IS  - 5
ER  -

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Author Information

Iyamu Collins Osaro

Division of Cardiothoracic & Vascular Surgery, University of Benin Teaching Hospital, Benin City, Nigeria

Contact Email

http://orcid.org/0009-0006-7292-2831
Okugbo Stanley Ukadike

Division of Cardiothoracic & Vascular Surgery, University of Benin Teaching Hospital, Benin City, Nigeria

http://orcid.org/0000-0002-1701-8907
Obanovwe Efemena

Division of Cardiothoracic & Vascular Surgery, University of Benin Teaching Hospital, Benin City, Nigeria

http://orcid.org/0009-0008-2365-3393

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APA Style

Osaro, I. C., Ukadike, O. S., Efemena, O. (2026). Primary Pulmonary Choriocarcinoma Presenting with Pulmonary Embolism and Hypomagnessemia-Induced Arrhythmia: A Rare and Diagnostically Challenging Case. International Journal of Cardiovascular and Thoracic Surgery, 12(5), 131-135. https://doi.org/10.11648/j.ijcts.20261205.13

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ACS Style

Osaro, I. C.; Ukadike, O. S.; Efemena, O. Primary Pulmonary Choriocarcinoma Presenting with Pulmonary Embolism and Hypomagnessemia-Induced Arrhythmia: A Rare and Diagnostically Challenging Case. Int. J. Cardiovasc. Thorac. Surg. 2026, 12(5), 131-135. doi: 10.11648/j.ijcts.20261205.13

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AMA Style

Osaro IC, Ukadike OS, Efemena O. Primary Pulmonary Choriocarcinoma Presenting with Pulmonary Embolism and Hypomagnessemia-Induced Arrhythmia: A Rare and Diagnostically Challenging Case. Int J Cardiovasc Thorac Surg. 2026;12(5):131-135. doi: 10.11648/j.ijcts.20261205.13

Copy | Download

@article{10.11648/j.ijcts.20261205.13,
  author = {Iyamu Collins Osaro and Okugbo Stanley Ukadike and Obanovwe Efemena},
  title = {Primary Pulmonary Choriocarcinoma Presenting with Pulmonary Embolism and Hypomagnessemia-Induced Arrhythmia: A Rare and Diagnostically Challenging Case},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {12},
  number = {5},
  pages = {131-135},
  doi = {10.11648/j.ijcts.20261205.13},
  url = {https://doi.org/10.11648/j.ijcts.20261205.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20261205.13},
  abstract = {Background: Choriocarcinoma is a germ cell tumour with highly malignant clinical behaviour. Its non-gestational, or primary subtype is associated with a poor prognosis and marked angioinvasiveness. Primary pulmonary choriocarcinoma (PPC) is exceedingly rare malignancy with no clinical guidelines developed for its treatment and the data on its symptomatology and optimal management remain limited. We report a 37-year-old woman who presented with sudden onset right-sided chest pain, dyspnoea, and cough. Computed tomography scan of the chest demonstrated a right-sided lung mass, and an initial percutaneous needle biopsy suggested a poorly differentiated lung carcinoma. She underwent right pneumonectomy, and postoperative histology of the resected mass confirmed pulmonary choriocarcinoma. While awaiting chemotherapy, she developed clinical features of pulmonary embolism and a malignant arrhythmia that markedly worsened her prognosis despite treatment. A dramatic clinical turnaround was experienced following intravenous magnesium sulphate correction of an incidentally detected hypomagnesemia. She commenced the etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen with a suboptimal response, and was subsequently transitioned to bleomycin, etoposide and cisplatin (BEP), on which she demonstrated marked clinical improvement. This case illustrates the diagnostic difficulty inherent in the evaluation of patients with primary pulmonary choriocarcinoma thus emphasizing the need to consider this rare entity in cases of lung masses, the central role of surgical resection within a multidisciplinary treatment strategy, and the often under-recognized contribution of hypomagnesemia to cardiovascular instability in critically ill oncology patients.},
 year = {2026}
}

Copy | Download

TY  - JOUR
T1  - Primary Pulmonary Choriocarcinoma Presenting with Pulmonary Embolism and Hypomagnessemia-Induced Arrhythmia: A Rare and Diagnostically Challenging Case
AU  - Iyamu Collins Osaro
AU  - Okugbo Stanley Ukadike
AU  - Obanovwe Efemena
Y1  - 2026/09/29
PY  - 2026
N1  - https://doi.org/10.11648/j.ijcts.20261205.13
DO  - 10.11648/j.ijcts.20261205.13
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 131
EP  - 135
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20261205.13
AB  - Background: Choriocarcinoma is a germ cell tumour with highly malignant clinical behaviour. Its non-gestational, or primary subtype is associated with a poor prognosis and marked angioinvasiveness. Primary pulmonary choriocarcinoma (PPC) is exceedingly rare malignancy with no clinical guidelines developed for its treatment and the data on its symptomatology and optimal management remain limited. We report a 37-year-old woman who presented with sudden onset right-sided chest pain, dyspnoea, and cough. Computed tomography scan of the chest demonstrated a right-sided lung mass, and an initial percutaneous needle biopsy suggested a poorly differentiated lung carcinoma. She underwent right pneumonectomy, and postoperative histology of the resected mass confirmed pulmonary choriocarcinoma. While awaiting chemotherapy, she developed clinical features of pulmonary embolism and a malignant arrhythmia that markedly worsened her prognosis despite treatment. A dramatic clinical turnaround was experienced following intravenous magnesium sulphate correction of an incidentally detected hypomagnesemia. She commenced the etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen with a suboptimal response, and was subsequently transitioned to bleomycin, etoposide and cisplatin (BEP), on which she demonstrated marked clinical improvement. This case illustrates the diagnostic difficulty inherent in the evaluation of patients with primary pulmonary choriocarcinoma thus emphasizing the need to consider this rare entity in cases of lung masses, the central role of surgical resection within a multidisciplinary treatment strategy, and the often under-recognized contribution of hypomagnesemia to cardiovascular instability in critically ill oncology patients.
VL  - 12
IS  - 5
ER  -

Copy | Download