Gastrointestinal bleeding caused by metastatic testicular choriocarcinoma: a case report and literature review

Abstract

Background Testicular tumor is one of the common solid tumors in young men. Testicular choriocarcinoma is a non-spermatogonial germ cell tumor, which is the rarest of all testicular cancers. Choriocarcinoma usually shows bleeding at the metastatic site, while gastrointestinal involvement is rare. Methods Here, we report a case of testicular choriocarcinoma with gastrointestinal bleeding as the first diagnosis and summarize the similar cases all over the world in recent 20 years. Results A 28-year-old male was treated with repeated melena for 2 months. No bleeding foci of the stomach, duodenum, colon, and rectum were found in endoscopy, and no bleeding foci of digestive tract was found in selective angiography, but a space occupying lesions of the lung, liver, and upper jejunum were found in chest and abdominal CT. Considering the possibility of a metastatic tumor and the ineffectiveness of medical treatment, the patient was converted to surgical treatment. The postoperative pathology was consistent with testicular choriocarcinoma. The patient received a chemotherapy regimen of paclitaxel, ifosfamide, and cisplatin. At present, the chemotherapy regimen is well tolerated. Conclusions The case report confirmed that even if we cannot find the logical relationship between clinical manifestations and genital examination, genital examination should also be part of the patient’s systematic examination.

A poor prognostic male choriocarcinoma with multiple systemic metastases: a case report and the literature review

“…Cryptorchidism may be one of the significant factors contributing to testicular choriocarcinoma. It has been reported that the likelihood of choriocarcinoma in cryptorchidism patients is 20–40 times higher compared to individuals with normal testes ( 65 , 66 ). The absence of the testicle in this particular case may be a significant factor contributing to the development of testicular choriocarcinoma.…”

“…According to the International Cooperative Organization for Germ Cell Cancer, a β-hCG level exceeding 50,000 mIU/mL signifies a poor prognosis. Some patients may manifest hyperthyroidism or bilateral gynecomastia, attributed to markedly elevated serum β-hCG levels, often exceeding 50,000 mIU/mL ( 66 , 72 ). In our case, elevated β-hCG levels stimulated supraphysiological testosterone secretion, subsequently aromatized to estradiol, resulting in gynecomastia.…”

“…The treatment approach for choriocarcinoma is contingent upon the disease’s stage ( 66 ). Non-gestational choriocarcinomas often receive a diagnosis in advanced or metastatic stages.…”

Testicular choriocarcinoma with pelvic and pulmonary metastases: a case report

“…In cases of recurrence, salvage chemotherapy with vincristine and ifosfamide may decrease tumor burden, but some patients may require palliative care ( 3 ). As fewer patients are included in Table 1 compared to the statistical analysis, it is clear that survival rates are significantly lower for patients treated solely with surgery, while combining surgery with other therapies markedly improves survival duration ( 13 , 14 ).…”

Testicular Mixed Germ Cell Tumor Presenting with Upper Gastrointestinal Bleeding: A Case Report

“…Upper gastrointestinal bleeding is an extremely rare initial manifestation of metastatic testicular germ cell tumors, particularly with duodenal involvement [19,20]. The most frequently reported gastrointestinal manifestations include abdominal pain (46%) and melena (44%), followed by hematemesis and hematochezia in approximately 24% of cases, while non-bloody vomiting, abdominal mass, and distension are less common [21]. Duodenal metastases usually present with melena and/or hematemesis, along with anemia.…”