Recovery from Choriocarcinoma Syndrome Associated with a Metastatic Extragonadal Germ Cell Tumor Hemorrhage

Abstract

A germ cell tumor is the most common form of malignancy in early male life, and can be classified as either seminomatous or nonseminomatous. Choriocarcinoma, comprised of nonseminomatous germ cells, is the most aggressive type of germ cell tumor and characteristically metastasizes to the retroperitoneal lymph nodes and less frequently to the lungs, liver, bone or brain [Shibuya et al., 2009;48: 551–554]. A 56-year-old man was admitted to another hospital complaining of abdominal distension. Symptoms included anorexia, vomiting, and diarrhea. The patient was diagnosed with an extragonadal germ cell tumor and referred to our hospital to receive chemotherapy. The day after admission, the patient’s abdominal distension gradually worsened. An emergency operation revealed venous hemorrhage from the surface of a metastatic extragonadal germ cell tumor between the ligament of Treitz and the inferior mesenteric vein in a horizontal position. Hemostatic treatment was performed with 4-0 proline thread attached to a medicated cotton sponge, rather than using a simple proline thread, and the closure area was manually compressed. Chemotherapy was initiated on postoperative day 10. A metastatic extragonadal germ cell tumor that causes massive hemorrhage and gastrointestinal hemorrhage is very rare, and represents a life-threatening emergency. If the patient’s condition carries a substantial risk of bleeding to death, it may be worthwhile to attempt abdominal operations.

Successful surgical management of massive hemoretroperitoneum caused by spontaneous rupture of retroperitoneal lymph node metastases in a patient with advanced mixed germ cell tumor: a COVID-19 pandemic-related surgical challenge

“…Urgent surgical exploration has been usually performed in a handful of similar cases reported in the literature. Komori et al [ 4 ] reported on the surgical management of hemoperitoneum caused by spontaneous rapture of a mixed germ cell tumor metastatic retroperitoneal lymph node mass penetrating the retroperitoneum between the ligament of Treitz and the inferior mesenteric vein. The patient had considerably high β-HCG and α-FP levels.…”

“…Despite significant intraoperative blood loss approximately 2 L, complete hemostasis has been accomplished with the patient withstanding the surgical procedure. Unfortunately, the patient died one month later because of massive gastrointestinal hemorrhage [ 4 ].…”

Choriocarcinoma Syndrome: A Rare and Serious Complication of Testicular Germ Cell Tumors

“…This is evident in a case of pulmonary hemorrhage that was successfully managed with lobectomy and prompt surgical intervention [ 11 ]. Moreover, Komori et al reported a case with metastatic extragonadal germ cell tumor who presented with hemoperitoneum that was treated surgically [ 12 ]. In our case, there were no well-defined culprit vessels to embolize or treat surgically.…”

Gastrointestinal Involvement of Testicular Germ Cell Tumor: A Case Report and Literature Review

“…Six of the 21 patients with follow-up information died, with a mean time to death of 25 days. Four of deaths were in patients diagnosed with choriocarcinoma, a more aggressive GCT associated with extensive metastasis and varied complication including massive hemorrhage [ 5 , 22 ].…”