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Metastatic Testicular Choriocarcinoma: An Unusual Cause of Upper Gastrointestinal Bleed. | LitMetric

AI Article Synopsis

  • Testicular cancer is the most prevalent type of cancer among males aged 15 to 44, with choriocarcinoma being a rare and aggressive subtype that spreads quickly, often to the lungs and brain.* -
  • A case study details a 30-year-old African American male with a history of stage III non-seminomatous germ cell testicular cancer who developed metastases in the lungs and stomach after failing to comply with chemotherapy.* -
  • Despite the rarity of gastrointestinal involvement in choriocarcinoma, this patient experienced melena, a significant drop in hemoglobin, and eventual diagnosis of metastatic choriocarcinoma in gastric nodules, although he ultimately declined further treatment.*

Article Abstract

Testicular cancer is the most common neoplasia in men between the ages of 15 to 44 years. Choriocarcinoma represents less than 2% of testicular tumors. It is usually characterized by an early hematogenous spread to the lungs and brain. Metastases to the gastrointestinal (GI) tract are extremely rare. Most metastatic lesions in the GI tract are seen in the small bowel. We present a 30-year-old African American male with a past medical history significant for stage III non-seminomatous germ cell testicular cancer. The patient was initially started on chemotherapy; however, he was not compliant with his treatment. One year following his diagnosis, he presented to the hospital with shortness of breath and chest pain. CT angiography of the chest was done and showed multiple masses scattered in all lung fields. The lesions were believed to be metastatic in nature. Laboratory testing showed a human chorionic gonadotropin beta level of 40,453 IU/L, LDH 258 IUnits/L, and alfa-fetoprotein 8.9 ng/mL. His hospital stay was complicated with melena and a drop in his hemoglobin from a baseline of 12 to 7 gm/dL. An esophagogastroduodenoscopy (EGD) showed three erythematous friable nodules in the gastric body. Biopsy results came back consistent with metastatic choriocarcinoma. The patient was offered salvage chemotherapy; however, he refused treatment and elected to proceed with suppurative measures. Testicular choriocarcinomas are the most aggressive and rapidly arising germ cell tumors. By the time they are diagnosed, large subsets of cases have already metastasized. Patients usually present with symptoms of hemorrhage in metastatic sites due to the high level of vascularization of those lesions. Gastrointestinal metastases from choriocarcinomas are very rare which account for 5% of all metastatic lesions with around 1% affecting the stomach. The presenting symptoms of stomach metastases are melena and/or hematemesis along with anemia. Although extremely rare, gastric metastases of choriocarcinoma should be kept in mind as part of the differential diagnosis for young patients with upper GI bleeding.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759043PMC
http://dx.doi.org/10.7759/cureus.5243DOI Listing

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