Testicular choriocarcinoma metastatic to skin and multiple organs. Two case reports and review of literature

Chen, Xinhua; Xu, Ling; Chen, Xinmei; Teng, Xiaodong; Zheng, Shusen

doi:10.1111/j.1600-0560.2009.01296.x

Cited by 17 publications

(17 citation statements)

References 13 publications

(22 reference statements)

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“…In few previously reported cases of testicular GCT with histologically multiorgan metastases by CC, the primary tumor also contained other components of A B C D GCT. [11][12][13][14] All CCs in this series, whether pure or predominant, presented with markedly high levels of serum b-hCG, mostly in the 100,000s range. Prior studies had shown that an elevated level of serum b-hCG, particularly >50,000 IU/L, is an independent indicator of poor outcome in testicular GCT.…”

Section: Discussionmentioning

confidence: 96%

Clinicopathologic Analysis of Choriocarcinoma as a Pure or Predominant Component of Germ Cell Tumor of the Testis

Alvarado‐Cabrero¹,

Hernández-Toriz

Paner

2014

American Journal of Surgical Pathology

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Although well recognized in the literature, the contemporary clinicopathologic data regarding choriocarcinoma (CC) as a pure or the predominant component of a testicular germ cell tumor (GCT) are limited. Herein, we present a series of pure CC and predominant CC in mixed GCT of the testis obtained from a single oncology institution. A comprehensive histologic review of 1010 orchiectomies from 1999 to 2011 yielded 6 (0.6%) pure CC and 9 (0.9%) mixed GCT cases with a predominant CC component. Patients' ages ranged from 20 to 39 years (median 29 y). All patients had markedly elevated serum β-hCG levels (median 199,000 IU/mL) at presentation. All tumors were unilateral and involved the right (9/15) and left (6/15) testis. The mean tumor size was 6.5 cm (range, 1.5 to 8 cm). Histology was similar for pure CCs and the CC component of mixed GCTs. CC commonly showed expansile hemorrhagic nodular cysts surrounded by variable layers of neoplastic trophoblastic cells (mononucleated trophoblasts and syncytiotrophoblasts). The syncytiotrophoblasts usually covered columns of mononucleated trophoblasts and occasionally formed plexiform aggregates and pseudovillous protrusions. Immunohistochemical stains suggested a mixture of cytotrophoblasts (p63+, HPL_) and intermediate trophoblasts (p63-, HPL weak +/-) in the columns of mononucleated cells. In the 9 mixed GCTs, CC comprised 50% to 95% (7/9 were ≥80% CC) of the tumor; 7 were combined with 1, and 2 were combined with 2 other GCT components. The non-CC components included teratoma (5/9), seminoma (2/9), yolk sac tumor (2/9), and embryonal carcinoma (2/9). Lymphovascular invasion, spermatic cord invasion, and tunica vaginalis invasion were present in 15/15, 5/15, and 1/12 cases, respectively. In mixed GCTs, these locally aggressive features were attributed to the CC component, except in 1 tumor in which it was also exhibited by the embryonal carcinoma component. Lymphovascular invasion was multifocal to widespread in 73% of tumors. The stages of the 15 tumors were: pT2 (10), pT3 (5); NX (1), N1 (4), N2 (5), N3 (5); and M1a (2) and M1b (13). Distant organ metastasis mostly involved the lungs (11) and liver (10). Follow-up information was available in 14 patients, all of whom received cisplatin-based chemotherapy. All 6 pure CC patients were dead of disease (range, 6 to 14 mo, median 9.5 mo). Follow-up of 8 patients with predominant CC (range, 10 to 72 mo, median 27 mo) showed that 5 died of the disease, and 1 was alive with disease and 2 were alive with no evidence of disease at 60 and 72 months of follow-up, respectively; these latter 2 patients were the only ones with M1a disease on presentation. This series confirms the proclivity for high-stage presentation including presence of distant metastasis, hematogenous spread, and poor outcome of testicular CC. Mixed GCT with a predominant CC component has similar tendency for high-stage presentation, marked elevation of serum β-hCG levels, and aggressive behavior compared with pure CC. This study also showed that distant metastasis ...

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Section: Discussionmentioning

confidence: 96%

Clinicopathologic Analysis of Choriocarcinoma as a Pure or Predominant Component of Germ Cell Tumor of the Testis

Alvarado‐Cabrero¹,

Hernández-Toriz

Paner

2014

American Journal of Surgical Pathology

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“…6 Choriocarcinomas are rare and may originate from fetal trophoblasts or germ cells in the testes or ovaries. They account for about 1% of all testicular carcinomas.…”

Section: Questions For Considerationmentioning

confidence: 99%

Clinical Reasoning: A 25-year-old man with headaches and collapse

Syed¹,

Westwood²

2013

Neurology

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“…Unlike other GCTs, choriocarcinomas metastasize early, spreading hematogenously to other sites, most often lung, liver, and brain. 6 Half of patients will have metastatic disease at the time of presentation. 2 Metastases have been reported in as many as 83% of patients, with most patients having multiple sites of metastases.…”

Section: Discussionmentioning

confidence: 99%

Metastatic Testicular Choriocarcinoma: A Rare Cause of Upper GI Bleeding

Lowe¹,

Paterson²,

Armstrong³

et al. 2016

ACG Case Reports Journal

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We present a case of upper gastrointestinal bleeding in an otherwise healthy 18-year-old man who presented with melena. Endoscopy revealed an ulcerated mass in the stomach and pathology confirmed this to be a malignant, poorly differentiated choriocarcinoma. Further imaging showed a left testicular mass with evidence of pulmonary, gastric, and brain metastases, and blood tests revealed an hCG level of 32,219 U/L. He was diagnosed with advanced metastatic testicular choriocarcinoma and underwent intensive induction chemotherapy and an orchidectomy. Metastatic testicular choriocarcinoma is a rare cause of gastrointestinal bleeding.

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Testicular choriocarcinoma metastatic to skin and multiple organs. Two case reports and review of literature

Cited by 17 publications

References 13 publications

Clinicopathologic Analysis of Choriocarcinoma as a Pure or Predominant Component of Germ Cell Tumor of the Testis

Clinicopathologic Analysis of Choriocarcinoma as a Pure or Predominant Component of Germ Cell Tumor of the Testis

Clinical Reasoning: A 25-year-old man with headaches and collapse

Metastatic Testicular Choriocarcinoma: A Rare Cause of Upper GI Bleeding

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