A Literature Review and Case Report of Metastatic Pure Choriocarcinoma

Abstract

In 2012, testicular cancer was estimated to account for 940 disability adjusted life years in Australia; of these, 450 were years lost due to premature death and 500 were years of healthy life lost due to disease, disability, or injury (Australian Institute of Health and Welfare and Australasian Association of Cancer Registries, 2012). Testicular choriocarcinoma is one of the rarest variants of testicular germ cell tumours, accounting for less than 1% of testicular germ cell tumours and only about 0.19% of all testicular tumours. Management involves radical orchidectomy and chemotherapy. Even then, prognosis is poor. This case report describes a 20-year-old male with pure testicular choriocarcinoma with pulmonary metastases which showed sustained and complete response to adjuvant chemotherapy consisting of bleomycin, etoposide, and cisplatin.

Pure testicular choriocarcinoma presenting as a friable hemorrhagic nodule on the lip

“…7 Cutaneous metastasis of testicular choriocarcinomas have been reported as angiomas, pyogenic granulomalike tumors, hemorrhagic nodules, or nontender subcutaneous nodules. 6 , 7 , 8 , 9 This case highlights the importance of prompt biopsy of these lesions, as this was the first presenting symptom of this tumor, and the diagnosis was only apparent after histologic examination.…”

“…Pure choriocarcinoma is even rarer and only represents 1% to 3% of all testicular GCTs and 0.19% of testicular cancers overall. 5 , 6 …”

Brain Metastasis of a Primary Testicular Pure Choriocarcinoma Presenting with Frontal Lobe Hemorrhage

“…Testicular choriocarcinoma makes up less than 1% of the testicular GCTs when it is pure, and only 0,19% of all testicular tumors. 2,4 In the present case, we have a young patient presenting with right frontal lobe hemorrhage, which led us to ask for a cerebral arteriography. The arteriography showed a ring lesion in the middle cerebral artery branch that suggested an AVM.…”

“…8 Brain metastases from the germ-cells occur in 4% of progressive testicular GCTs 3 ; and the literature suggests a poor prognostic for these cases. 4 The serum levels of β-HCG can be used to support choriocar-cinoma diagnosis and treatment, once it tends to decrease after effective treatment of the primary lesion. 6 In the case presented, a successful treatment for the cerebral metastasis was performed, with complete remission of the neurological symptoms.…”

“…However, even with an early treatment, the literature suggests a poor prognosis in metastatic cases. 4 After reviewing the literature, we started looking for the primary lesion. In this specific case, we asked for a β-HCG, a new chest X-Ray and a testicular ultrasound, but the literature also suggests that measuring β-HCG concentrations in cerebral spinal fluid is a more sensitive and reliable indicator of tumor presence.…”