A case of metastatic testicular cancer complicated by pulmonary hemorrhage due to choriocarcinoma syndrome

Abstract

A 40-year-old man was referred to our hospital for treatment of metastatic testicular cancer. Computerized tomography revealed multiple lung, liver, and retroperitoneal lymph node metastases. In addition, magnetic resonance imaging revealed multiple brain metastases. Induction chemotherapy with bleomycin, etoposide, and cisplatin was started the day after a high orchiectomy. The pathological diagnosis of the surgical specimen was yolk sac carcinoma. The serum human chorionic gonadotropin (hCG) was markedly increased to 630,000 mIU/ml, which suggested the presence of a choriocarcinoma element at metastatic sites. The patient subsequently suffered respiratory failure due to pulmonary hemorrhage. Intensive supportive care prevented a fatal outcome. Physicians who treat advanced testicular tumors should be aware of the potential complication of acute pulmonary hemorrhage, called choriocarcinoma syndrome, in cases with a high hCG level, which indicates a rapidly progressive and high-volume choriocarcinoma.

Successful treatment of multisite hemorrhage by several methods in brain metastasis of choriocarcinoma

“…Our patient had been treated with EMACO regimen, which is the first-line chemotherapy regimen in GTN patients with a high risk. [11] Our successful treatment also confirmed the effectiveness of the proposed scheme in patients with brain metastasis of choriocarcinoma.…”

Oncological Outcomes of Metastatic Testicular Cancers under Centralized Management through Regional Medical Network

“…This mortality rate of BEP is in sharp contrast to those of recently published RCTs for good-prognosis patients, where only one treatment-related death occurred among 250 patients (13). In the present series, three cases suffered from severe complications during BEP: two patients with massive hemorrhage from metastases (25,26) and one patient with duodenal perforation due to a necrotized retroperitoneal mass. All the three patients had poor-prognosis disease.…”

Choriocarcinoma Syndrome as an Initial Presentation of Testicular Cancer

“…Physicians should be aware of the potential complications that occur with CS during the treatment of testicular cancer with high β -hCG levels, which could be associated with a rapidly progressive high-volume disease. Patients in this category should be referred to the centers experienced in the treatment of advanced germ-cell tumors [ 11 ]. Due to the severity of the presentation, hemodynamic monitoring, ideally in an intensive care unit, is essential as well as timely administration of cytotoxic treatment.…”