Objective  Primary gastric choriocarcinoma (PGC) is a rare tumor.This study aimed to analyze cases reported in Chinese and two cases in our hospital.This study was also conducted to investigate the clinical characteristics and treatment of PGC.

  Methods  The Chinese Medical Current Contents and China Biology Medicine database was retrieved with the following terms:primary gastric choriocarcinoma, stomach choriocarcinoma, and ectopic choriocarcinoma.The clinical data in published literature were retrospectively analyzed.Two cases from our hospital were also retrospectively analyzed.

  Results  A total of 16 patients with PGC (14 case studies and 2 cases from our hospital) were included in this study.The average age of the patients was 57.69 years (ranging from 42 years to 79 years).Among the 16 patients, 4 were females and 12 were males.The main clinical manifestation was abdominal discomfort (12/ 16).Laboratory and imaging tests were non-specific, but HCG-β in all of the patients increased (11/11).Organ or lymph node metastasis was found in 13 patients, including 6 cases in which two or more organs showed metastasis.These organs were primarily the liver, the stomach lymph nodes, the lungs, the brain, and the abdominal cavity.Pathological examination results showed that 12 of the 16 cases displayed ulcers with necrosis and hemorrhage.The four remaining cases manifested lesions.Lesions may occur in the stomach lesser curvature (5 cases), stomach sinus (6 cases), cardiac (2 cases), and gastric body (3 cases).The histological components of PGC co-existed with other factors, such as adenocarcinoma (7 cases), adenocarcinoma and squamous (2 cases), adenocarcinoma and a signet ring cell (1 case), or pure choriocarcinoma (6 cases).Surgery combined with chemotherapy was the main treatment.A total of 14 patients underwent surgical operations.Among these patients seven underwent chemotherapy after surgery and one underwent chemotherapy. Among the 10 patients who were followed up, 8 died within six months after diagnosis.

  Conclusion  PGC is a rare stomach cancer with poor prognosis and primarily affects older men.No characteristic clinical manifestations were observed, but HCG-β as a specific serum tumor biomarker increased in all of the affected patients.Histological components co-existed with other stomach cancers.Surgical excision combined with chemotherapy was the preferred treatment in early stages, and systemic chemotherapy was the recommended treatment in advanced stages.