Metastatic Testicular Choriocarcinoma: A Rare Cause of Upper GI Bleeding

Abstract

We present a case of upper gastrointestinal bleeding in an otherwise healthy 18-year-old man who presented with melena. Endoscopy revealed an ulcerated mass in the stomach and pathology confirmed this to be a malignant, poorly differentiated choriocarcinoma. Further imaging showed a left testicular mass with evidence of pulmonary, gastric, and brain metastases, and blood tests revealed an hCG level of 32,219 U/L. He was diagnosed with advanced metastatic testicular choriocarcinoma and underwent intensive induction chemotherapy and an orchidectomy. Metastatic testicular choriocarcinoma is a rare cause of gastrointestinal bleeding.

Brain Metastasis of a Primary Testicular Pure Choriocarcinoma Presenting with Frontal Lobe Hemorrhage

“…Testicular choriocarcinoma makes up less than 1% of the testicular GCTs when it is pure, and only 0,19% of all testicular tumors. 2,4 In the present case, we have a young patient presenting with right frontal lobe hemorrhage, which led us to ask for a cerebral arteriography. The arteriography showed a ring lesion in the middle cerebral artery branch that suggested an AVM.…”

“…1 This kind of cell tumor may develop in the testicles, however, with low incidence, accounting for only 1-2% of all malignant tumors found in men. 2 This is the case of a young man, who came to our service with left hemiparesis, and a right frontal lobe hemorrhage. After diagnosed with a brain arteriovenous malformation (AVM), he underwent a craniotomy for surgical treatment.…”

Gastrointestinal Bleeding with Hemodynamic Repercussion due to a Gastric Metastatic Lesion of a Testicular Choriocarcinoma in a Previously Asymptomatic Young Adult

“…He was safely discharged home a few days later and now follows up in the outpatient oncology clinic for chemotherapy. Testicular germ cell (TGC) tumors are extremely rare tumors accounting for less than 2% of malignancies in the male population [1]. A pure testicular choriocarcinoma (TC) represents 0.3% of these TGC tumors and is known to be a very aggressive form [2].…”

“…Gastrointestinal involvement occurs in less than 5% from primary TC and can present as hematemesis or melena. Bleeding can also occur in any other organs such as lungs, brain, or peritoneum [1].…”

“…Serum HCG testing proves as a useful noninvasive marker even in men for detection and monitoring of this malignancy [1,4]. Young men with gastric ulceration should always have a thorough genital physical examination and should be investigated further to exclude any concerns of malignancy.…”