No abstract

We present an unusual case of a 23-year-old Hispanic male with no past medical history, who presented with 2 days history of diffuse abdominal pain. CT scan showed widely bleeding metastatic lesions in the retroperitoneum, lungs and liver causing large hemothorax and hemoperitoneum. He developed acute symptomatic anemia and needed interventional radiology-guided embolization of hepatic artery in addition with an urgent chest tube to relieve the symptoms along with transfusion. Subsequent exam found a true choriocarcinoma of the right testis. Following chemotherapy, the patient's lesions shrunk and his anemia improved. A review of literature shows that testicular choriocarcinoma is a rare aggressive malignancy which metastasizes hematogenously and bleeds extensively due to their high vascularity. They can present with acute symptoms and signs that often lead patients to seek emergency care. Acute bleeding manifestation could be also the first presentation often leading to the final diagnosis of choriocarcinoma like in this case.

This is a case of a 60-year-old Hispanic male with a history of poorly controlled diabetes who presented to the hospital with a chief complaint of a mass in the penis with mucopurulent discharge and drainage. The patient reported that the mass has been present for one year and had increased in size over the past six months. The patient had the mass biopsied at an outside surgical center one year ago, which was supposedly negative for cancer. On the initial physical examination, there was a large exophytic necrotic mass entirely replacing the penis with complete obliteration of the normal architecture of the glans and phallus with foul, purulent discharge. Significant bilateral palpable inguinal lymphadenopathy was present. A bedside biopsy was performed, which revealed squamous cell carcinoma (SCC). Computed tomography (CT) of the chest, abdomen, and pelvis was ordered for staging and revealed extensive pulmonary and hepatic metastasis, as well as bulky inguinal and retroperitoneal lymph node involvement. Systemic chemotherapy was offered to the patient; however, the patient declined and opted for hospice.