Advanced testicular cancer associated with life-threatening tumour lysis syndrome and choriocarcinoma syndrome

Abstract

Tumour lysis syndrome (TLS) and choriocarcinoma syndrome (CS) are severe complications of chemotherapy for testicular cancer. They are rare, but can be life-threatening. A 37-year-old man complaining of persisting cough was referred to our hospital. A computed tomography (CT) scan revealed huge tumours that occupied the peritoneal cavity, with multiple lung, liver, and para-aortic metastases. Although there was no abnormal finding in the testes, serum testicular tumor markers showed marked elevation. A CT-guided biopsy for the peritoneal tumours revealed extragonadal germ cell tumour (GCT), including yolk sac tumour and choriocarcinoma. Chemotherapy with bleomycin, etoposide, and cisplatin (BEP) was started after admission. The morning after the beginning of BEP, the patient developed hemorrhagic shock, in addition to acute pulmonary and renal failure, because of TLS and massive hemorrhage at bilateral lung metastases. He was intubated and resuscitated. Despite appropriate therapy, his renal function did not recover and hemodialysis was started. The patient eventually died of severe respiratory distress syndrome and infection. To our knowledge, this is the first case report of TLS and CS as complications of hemorrhage at the lung metastases of advanced testicular cancer leading to death.

Metastatic choriocarcinoma induced separate simultaneous intracerebral haemorrhages: a very rare occurrence and its novel association with Klinefelter syndrome

“…BEP is a standard chemotherapy regimen for advanced testicular cancers and has been shown to be effective in the management of testicular choriocarcinoma with lung metastases 12 13. In our case, the combination of acute surgery and BEP was shown to have life-saving and curative potential in the treatment of SSIH and of the causative testicular choriocarcinoma with brain metastases.…”

Case of acute respiratory distress syndrome in a patient with an extragonadal germ cell tumor without lung metastasis in which choriocarcinoma syndrome was suspected

“…It has been reported that choriocarcinoma syndrome should be suspected in patients who exhibit high HCG levels, large tumors, and multiple metastases in the early stages of chemotherapy . ARDS due to bleeding from lung metastases has been well characterized, and there have also been reports about bleeding from liver and brain metastases…”

Disseminated gestational choriocarcinoma presenting with hepatic and uveal metastases, hook effect, and choriocarcinoma syndrome

“…[1] One of the remarkable features of CC is extensive necrosis so much so that the primary site may sometimes be barely discernible. [1] Necrosis sometimes can give rise to clinically manifest hemorrhage at high tumor-volume metastatic sites, described by Logothetis as choriocarcinoma syndrome,[5] with diffuse alveolar hemorrhage as the most common manifestation. [5] The syndrome portends a poor prognosis[5] and needs early recognition and urgent treatment.…”

“…[1] Necrosis sometimes can give rise to clinically manifest hemorrhage at high tumor-volume metastatic sites, described by Logothetis as choriocarcinoma syndrome,[5] with diffuse alveolar hemorrhage as the most common manifestation. [5] The syndrome portends a poor prognosis[5] and needs early recognition and urgent treatment. [5] Our patient underwent hemorrhage within the pleural space followed by the peritoneal cavity.…”

“…[5] The syndrome portends a poor prognosis[5] and needs early recognition and urgent treatment. [5] Our patient underwent hemorrhage within the pleural space followed by the peritoneal cavity.…”