Pure testicular choriocarcinoma Cannonball metastases as a presenting imaging feature: A case report and a review of literature

Aftan, Mohanad Kareem; Badrawi, Noor; Abdulghaffar, Shareefa; Abedzadeh, Ayoub; Albastaki, Usama; Raman, Lakshmiah G.; Alzeena, Ethar

doi:10.1016/j.radcr.2021.01.053

Cited by 3 publications

(2 citation statements)

References 13 publications

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“…Laboratory investigation involves tumor markers such as β-HCG and AFP. β-HCG is significantly high in pure choriocarcinoma (> 1000 IU/L, normal range is < 2 mIU/mL) and choriocarcinoma does not produce AFP ( 11 ). The standard radiologic test for testicular choriocarcinoma is ultrasound.…”

Section: Discussionmentioning

confidence: 99%

Case report: A case with atypical presentation oftesticular choriocarcinoma

Zhong,

Zhang,

Dong

et al. 2024

Front. Oncol.

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Testicular choriocarcinoma is a relatively rare malignancy with a highly aggressive nature. Timely diagnosis and treatment can help prolong the survival of patients and even cure them. This case reports a 29-year-old male who presented to the clinic for a month with epigastric pain. On examination, a massive mass of approximately 9*10 cm could be palpated in the upper abdomen. When asked about his previous history, the patient only described a history of a right inguinal hernia that had been repaired 12 years earlier. The admission diagnosis was considered the retroperitoneal tumor, which was found to have metastasized to the liver and lungs after the completion of relevant tests. We then performed a CT-guided lune puncture biopsy on day 8 of admission. The biopsy pathology suggested metastatic cancer was considered. As the symptoms of tumor compression gradually worsened, we performed surgical treatment (retroperitoneal tumor resection + partial duodenal resection + enteroanastomosis) on day 13 of admission. The postoperative pathology was choriocarcinoma. We subsequently conducted a detailed inquiry with the patient’s family about his medical history and found a history of inguinal testicle. Through testicular ultrasound examination, it was preliminarily determined to be testicular choriocarcinoma (not yet pathologically confirmed). We wanted to start salvage chemotherapy as soon as possible after surgery. However, the patient’s postoperative condition was poor, with rapid progression of hepatopulmonary metastases and gradually increased thyrotoxicosis, and we started salvage chemotherapy (EP regimen: etoposide and cisplatin) on postoperative day 12. However, the patient was forced to stop due to a severe chemotherapy reaction and died of respiratory and cardiac arrest in the hospital. For male patients with retroperitoneal mass, the possibility of germ-cell neoplasm should first be excluded. By inquiring in detail about a history of cryptorchidism and in the initial days of hospitalization, testicular exploration, ultrasounds, and serum tumor markers (AFP, β-HCG) tests can be conducted to rule out the possibility of germ-cell neoplasm, thereby preventing misdiagnosis and treatment delays. If the clinical diagnosis is metastatic germ-cell tumor with severe symptoms of metastatic disease, surgery should never be used as the initial treatment.

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Section: Discussionmentioning

confidence: 99%

Case report: A case with atypical presentation oftesticular choriocarcinoma

Zhong,

Zhang,

Dong

et al. 2024

Front. Oncol.

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“…A "Cannonball" appearance, described as homogeneous multiple rounded opacities on chest radiograph, may indicate an advanced stage of disease with a bad prognosis and survival rate [1]. The radiographical appearance in lung imaging could be found in many diagnoses including fungal and bacterial infections, granulomas, immunodeficiencies, and malignancy metastases; the latter being the most prevalent etiology of the aforementioned appearance, arising typically from renal carcinoma, head and neck squamous cell carcinoma, and human chorionic gonadotrophin-associated choriocarcinoma [1,2]. A cannonball's appearance in the lung is due to the lung's nature of being one of the most common sites of metastases of any carcinoma type [3].…”

Section: Introductionmentioning

confidence: 99%

Atypical Radiology Imaging of Squamous Cell Lung Carcinoma: A Case Report and Narrative Review

Utomo

Rustam

Sudharmadji

2023

Indonesian Journal of Cancer

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Introduction: Multiple well-circumscribed round nodules, also known as “Cannonball” appearance in the lungs, are typically associated with specific pulmonary metastases. However, limited reports denote the finding, especially if correlated with primary squamous cell lung carcinoma in the younger population. This is the first case report in Indonesia of a 19-year-old male with primary squamous cell carcinoma in the lung and chest radiograph image mimicking a “Cannonball” appearance Case Presentation: A 19-year-old male was presented with a history of progressing hemoptysis for two weeks with no other abnormal respiratory symptoms but a reduction of vocal fremitus. The subject is an occasional smoker and had a history of lung tuberculosis in 2009 and a suprarenal or adrenal mass. X-ray imaging revealed multiple bilateral pulmonary nodules, mimicking the “Cannonball” appearance. A fine needle aspiration (FNA) biopsy of a nodule was done and interpreted to be primary squamous cell carcinoma. Symptomatic treatment was given and the subject was discharged on the fifth day. Conclusions: A “Cannonball” appearance or its mimic is not always typical to certain carcinoma based on what this case report finds. In the case of a tumor, radiograph findings should also be correlated with other supporting tests such as biopsy and clinical presentation.

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