Acute Clinical Presentation of Metastatic Testicular Choriocarcinoma: A Case Report and Brief Review of Literature

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.

Pure Testicular Choriocarcinoma with Dermatological, Brain, and Gastrointestinal Metastases

“…Gastrointestinal metastases of choriocarcinoma is also exceedingly rare. Approximately 5% of patients with germ-cell tumors are found to have gastrointestinal metastases [ 13 ]; however, metastases from pure choriocarcinoma is much rarer [ 14 - 17 ]. Metastases to the gastrointestinal tract is thought to be either from direct spread from adjacent retroperitoneal lymph nodes or as a result of hematogenous spread.…”