Pure choriocarcinoma of the testis presenting with jaundice: a case report and review of the literature

Abstract

IntroductionTesticular cancer is the most common malignancy in men 15- to 35-years-old. The North American standard classification divides testicular cancers into germ cell tumors and non-germ cell tumors. The lymphatic spread of germ cell tumors usually involves the retroperitoneal lymph nodes. However, this spread to the retroperitoneum rarely involves the hepatic hilum. We describe an unusual case of metastatic choriocarcinoma of the testis that was clinically mimicked by a cholestatic jaundice. This is an unusual presentation of testicular cancer and, to the best of our knowledge, the first report of this kind in the literature.Case presentationA 28-year-old Moroccan man presented with a four-week history of progressive obstructive jaundice, and weight loss to our emergency department. Abdominal ultrasound showed a dilatation of the biliary ducts due to pathologically enlarged lymph nodes of the hepatic hilum. A complete clinical and radiologic assessment to discover the primary tumor was negative except for pulmonary metastasis. In the laboratory findings at admission there were signs of cholestasis with an abnormal increase in the rate of testicular tumor markers (serum beta-human chorionic gonadotropin level was 11,000IU/ml), which subsequently led to the suspicion of a testicular tumor. Further evaluation included testicular palpation and ultrasound which revealed a testicular nodule. The patient underwent an inguinal orchidectomy of the right testis and histopathological examination confirmed a pure choriocarcinoma. The prognosis was poor due to lymph node involvement at the hepatic hilum. He died one month later, despite general chemotherapy.ConclusionsThe clinical presentation of the disease and the rarity of this entity are two remarkable characteristics described in this case report which are rarely reported in literature.

A case report of testicular choriocarcinoma complicated with pneumothorax

“…Cisplatinbased chemotherapy is the cornerstone of treating patients with metastatic non-seminomatous germ cell tumours [14]. However, other clinicians in case reports have found that pure choriocarcinomas are not as sensitive to chemotherapy as NSGCTs, possibly because of their high malignant potential and poor prognosis which is associated with early hematogenous metastasis and its associated complications [17] which this report confirms. When this kind of tumour is diagnosed early, it responds well to chemotherapy.…”

Clinicopathologic Analysis of Choriocarcinoma as a Pure or Predominant Component of Germ Cell Tumor of the Testis

“…In the past almost 4 decades, pure CC of the testis has only been the subject of case reports. [6][7][8][9] Contemporary clinical and pathologic information of pure CC of the testis, particularly in this era of chemotherapy as a standard for GCT, is limited. It is also unclear whether testicular GCT with a predominant CC component will have a similar behavior to pure CC and how the predominant CC component will impact the pathologic variables in a mixed GCT.…”

Testicular Germ Cell Tumors

“…However, occasionally in this context or more frequently when extensive, predominant, or pure, CC presents as metastatic disease, with symptoms related to hemorrhagic metastasis (hemoptysis, melena, intracranial hemorrhage, etc.) [149][150][151][152]. In these cases, a clinically evident primary may not be readily apparent.…”