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Acute presentation of choriocarcinoma: a case study and review of the literature

Published online by Cambridge University Press:  21 May 2015

Andrew Worster ,
Sangita Sharma ,
Farouk Mookadam  and
John Opie
Andrew Worster*
Affiliation:
Departments of Emergency Medicine, Medicine, Hamilton Health Sciences Corporation and McMaster University, Hamilton, Ont.
Sangita Sharma
Affiliation:
Medicine, Hamilton Health Sciences Corporation and McMaster University, Hamilton, Ont.
Farouk Mookadam
Affiliation:
Department of Cardiovascular Disease, The Mayo Clinic, Rochester, Minn
John Opie
Affiliation:
Departments of Emergency Medicine, Medicine, Hamilton Health Sciences Corporation and McMaster University, Hamilton, Ont.
*
Division of Emergency Medicine, Hamilton Health Sciences, 237 Barton St. E, Hamilton ON L8N 3Z5; 905 521-2100 x73136, fax 905 527-7051, aworster@rogers.com

Abstract

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We report an unusual case of a 27-year-old male with an acute presentation of choriocarcinoma. The patient presented with unstable vital signs, severe anemia and a widened arterial pulse pressure following a several day history of testicular pain. He was subsequently diagnosed as having testicular choriocarcinoma with multiple hepatic metastases and large hemorrhagic para-aortic lymph nodes. The widened pulse pressure persisted during fluid resuscitation and correction of both the anemia and hypotension, and only narrowed after the initiation of chemotherapy. A literature review indicates that metastatic testicular choriocarcinoma is a rare but aggressive malignancy that often presents with acute symptoms and signs that cause patients to seek emergency care. We summarize the reported cases of “acute” testicular choriocarcinoma presentation and briefly discuss its relationship to widened arterial pulse pressure.

Keywords

choriocarcinomatesticular neoplasmspulse pressureshockemergency medicine
Type
Case Report • Observations
Information
Canadian Journal of Emergency Medicine , Volume 4 , Issue 2 , March 2002 , pp. 111 - 114
Copyright
Copyright © Canadian Association of Emergency Physicians 2002

References

1.Schottenfeld, D, Warshauer, ME, Sherlock, S, Zauber, AG, Leder, M, Payne, R.The epidemiology of testicular cancer in young adults. Am J Epidemiol 1980;112:232–46.CrossRefGoogle ScholarPubMed
2.Wingo, PA, Tong, T, Bolden, S.Cancer statistics, 1995. CA Cancer J Clin 1995;45:8–30.CrossRefGoogle ScholarPubMed
3.Mostofi, FK.Testicular tumors: epidemiologic, etiologic and pathologic features. Cancer 1973;32:1186–201.3.0.CO;2-8>CrossRefGoogle ScholarPubMed
4.Zondek, B.Versuch einer biologischen (hormonalen) diagnostik beim malignen hodentumor. Chirug 1930;2:1072–80.Google Scholar
5.Bosl, GJ, Lange, PH, Nochomovitz, LE, Goldmann, A, Fraley, EE, Rosai, J, et al.. Tumor markers in advanced nonseminomatous testicular cancer. Cancer 1981;47(3):572–6.Google Scholar
6.Catalona, WJ.Tumor markers in testicular cancer. Urol Clin N America 1979;6:613–28.CrossRefGoogle ScholarPubMed
7.Giralt, SA, Dexeus, F, Amato, R, Sella, A, Logothetis, C.Hyperthyroidism in men with germ cell tumors and high levels of beta-human chorionic gonadotropin. Cancer 1992;69:1286–90.Google Scholar
8.Cotran. Robbins pathologic basis of disease. 6th ed. Philadelphia: WB Saunders Company; 1999.Google Scholar
9.Richie, JP.Advances in the diagnosis and treatment of testicular cancer. Cancer Invest 1993;11:670–5.CrossRefGoogle ScholarPubMed
10.Stokes, EW, Perkins, C.Testicular choriocarcinoma: an unusual presentation as occult gastrointestinal blood loss. J Adoles Health Care 1989;10:146–50.Google Scholar
11.Benditt, JO, Farber, HW, Wright, J, Karnad, AB.Pulmonary hemorrhage with diffuse alveolar infiltrates in men with high-volume choriocarcinoma. Ann Intern Med 1988;108:674–5.Google Scholar
12.Tariq, M, Glucman, P, Thebe, P.Metastatic testicular teratoma of the nasal cavity: a rare cause of severe intractable epistaxis. J Laryngol Otol 1998;112:1078–81.CrossRefGoogle ScholarPubMed
13.Cutajar, CL.Spontaneous rupture of testicular teratoma. Br Med J 1972;1:154–5.Google Scholar
14.Nishizaki, T, Orita, T, Tsuha, M, Wakuta, Y, Fujii, M, Ito, H.Brain metastasis of testicular tumor with massive hemorrhage — report of two cases. Neurol Med Chir (Tokyo) 1991;31:586–9.CrossRefGoogle ScholarPubMed
15.Kidd, D, Plant, GT, Scaravilli, F, McCartney, AC, Stanford, M, Graham, EM.Metastatic choriocarcinoma presenting as multiple intracerebral haemorrhages: the role of imaging in the elucidation of the pathology. J Neurol Neurosurg Psychiatry 1998;65:939–41.Google Scholar
16.Watkins, GL.Massive hemoperitoneum resulting from rupture of a seminoma in an undescended testicle. J Urol 1970;103:447–8.CrossRefGoogle Scholar
17.Fidler, IJ.Critical factors in the biology of human cancer metastasis: twenty-eighth G.H.A. Clowes memorial award lecture. Cancer Res 1990;50:6130–8.Google ScholarPubMed
18.Lox, CD, Trevino, J.Abnormal hematological indices associated with metastatic choriocarcinoma in a young man. J Med 1983;14:95–101.Google ScholarPubMed
19.Hassan, B, Tung, K, Weeks, R, Mead, GM.The management of inferior vena cava obstruction complicating metastatic germ cell tumors. Cancer 1999;85:912–8.Google Scholar
20.Bone, RC, et al. Pulmonary and critical care medicine [electronic resource]: your single-source reference library on CD-ROM. 1998 ed. St. Louis: Mosby-Year Book, Inc; 1998.Google Scholar
21.Haab, F, Cour, F, Boutan Laroze, A, Squara, P, Lucas, G.Testicular neoplasm presenting as a major pulmonary embolism. Eur Urol 1996; 29:494–6.CrossRefGoogle ScholarPubMed
22.Karila-Cohen, D, Mentec, H, Bleichner, G.Testicular choriocarcinoma revealed by a localized pulmonary edema: a case report. Intensive Care Med 1995;21:1036–8.Google Scholar
23.McGowan, MP, Pratter, MR, Nash, G.Primary testicular choriocarcinoma with pulmonary metastases presenting as ARDS. Chest 1990;97:1258–9.Google Scholar
24.Winterbauer, RH, Elfenbein, IB, Ball WC: Incidence and clinical significance of tumor embolization to the lungs. Am J Med 1968;45:271–90.Google Scholar
25.Kupari, M, Laitinen, L, Hekali, P, Luomanmaki, K.Cor pulmonale due to tumor cell embolization. Acta Med Scand 1984;210:507–10.Google Scholar
26.Kane, RD, Hawkins, HK, Miller, JA, Noce, PS.Microscopic pulmonary tumor emboli associated with dyspnea. Cancer 1975; 36:1473–82.Google Scholar
27.Gleason, PE, Elliott, DS, Zimmerman, D, Smithson, WA, Kramer, SA.Metastatic testicular choriocarcinoma and secondary hyperthyroidism: case report and review of the literature. J Urol 1994;151:1063–4.Google Scholar
28.Goodarzi, MO, Van Herle, AJ.Thyrotoxicosis in a male patient associated with excess human chorionic gonadotropin production by germ cell tumor. Thyroid 2000;10:611–9.CrossRefGoogle Scholar
29.Hofflander, R, Beckes, D, Kapre, S, Matolo, N, Liu, S.A case of jejunal intussusception with gastrointestinal bleeding caused by metastatic testicular germ cell cancer. Dig Surg 1999;16:439–40.CrossRefGoogle ScholarPubMed
30.Yoshida, S, Morii, K.Brain metastasis from germinal tumors of the testis. Case report. J Neurosurg 1990;88:761–3.CrossRefGoogle Scholar
31.Bettocchi, C, Coker, CB, Traficante, A, Selvaggi, FP.Testicular cancer presenting as loss of vision. Br J Urol 1995;76:519–20.CrossRefGoogle ScholarPubMed
32.Roberts, JR.Clinical procedures in emergency medicine. 3rd ed. Philadelphia: WB Saunders; 1998.Google Scholar
33.Guyton, AC, Hall, JE.Textbook of medical physiology. 9th ed. Philadelphia: WB Saunders; 1996.Google Scholar
34.Murray, JC, Oshman, D, Steuber, CP.Diastolic runoff with widened arterial pulse pressure in an adolescent with widely metastatic testicular choriocarcinoma. Pediatr Cardiol 1995;16:145–6.Google Scholar
35.Kitamura, K.TPN-induced fulminant beriberi: a report on our experience and a review of the literature. Surg Today 1996;26:769–76.CrossRefGoogle Scholar