Choroidal metastases in testicular choriocarcinoma, successful treatment with chemo- and radiotherapy: a case report

Abstract

BackgroundChoriocarcinoma is a very rare cause of ocular metastasis. Only 18 male patients have been reported on, 4 of whom survived, but with significant loss of vision.Case presentationA 26-year-old Caucasian man, suffering from testicular choriocarcinoma with pulmonary, cerebral, renal, hepatic and osseous metastases, underwent left radical orchiectomy. While being treated with chemotherapy, he presented with loss of vision in the left eye. Ophthalmoscopy revealed bilateral non-pigmented, hemorrhagic choroidal tumours, compatible with secondary lesions. Continued chemotherapy and stereotactic radiotherapy of the skull and spine lead to full remission with excellent vision, after more than 4 years of follow up.ConclusionTesticular choriocarcinoma is an exceptional cause of choroidal metastasis, potentially asymptomatic and with specific clinical features. Radiotherapy can complement radical orchiectomy and chemotherapy, to achieve full remission and maintain good vision.

Metastatic choriocarcinoma to the lumbar spine: Case report and review of literature

“…Table 1 presents all cases of reported spinal metastases found in a comprehensive literature search. [ 1 2 3 4 6 9 10 11 13 14 16 21 22 ] The first three reported cases of spinal choriocarcinoma in other young males all represent cases of advanced multi-system disease burden as in the case reported here. In fact, in two of the three prior cases, the spinal involvement was only found upon autopsy.…”

“…[ 1 22 ] In the living male patient with spine, brain, kidney, lung, liver, and eye involvement, chemotherapeutic and radiation treatments have provided an excellent outcome for at least 4 years. [ 6 ] With an incidence of 0.5% of all testicular tumors, pure choriocarcinoma is very rare in men and typically originates from totipotent gonadal germ cells but often presents with advanced metastases. [ 15 ] Contrary to the success observed with chemotherapeutic treatment of choriocarcinoma of paternal genetic origin more commonly seen in women who have experienced a hydatidiform mole (80% remission even in widely metastatic cases), the prognosis in men with this disease remains grim.…”

“…Nonetheless, select case reports describing surprising success in several men with advanced disease burden hold some hope for the possibility of medical cure. [ 6 8 ]…”

Gestational Choriocarcinoma Presenting with Lacrimal Gland Metastasis: A First Reported Case

“…Choriocarcinoma has shown metastasis to the orbit, particularly retinal choroid predominantly reported from the male pathological counterparts, testicular choriocarcinoma [ 13 , 15 ]. A few cases of GC metastasis to the retinal choroid and extraocular muscles have also been reported [ 6 , 14 , 16 ].…”

“…This is the same applied to orbital GC metastases with EMA/CO chemotherapy regimen without [ 16 ] or with local radiotherapy [ 15 ]. Our patient has shown complete response to chemotherapy and whole brain radiation with good recovery from the unusual ocular as well as other metastatic lesions.…”