Choriocarcinoma Syndrome as an Initial Presentation of Testicular Cancer

الملخص EN

Choriocarcinoma syndrome (CS) is a rare clinical entity within the spectrum of nonseminomatous germ-cell tumors (NSGCT).

It is characterized by the abrupt establishment of rapidly progressive and hemorrhagic tumors associated with very high levels of the beta fraction of human chorionic gonadotropin (β-hCG) and with a very poor prognosis, particularly in patients with β-hCG values above 50,000 IU/L.

We present the case of a 17-year-old man with a sudden onset nonmassive hemoptysis.

Physical examination revealed a right testicular mass.

Imaging studies showed metastatic lung, bone, and retroperitoneal disease.

β-hCG serum levels were 222,493.21 IU/L, AFP 1.56 ng/mL, and DHL 457 IU/L.

Histopathological study after right radical orchiectomy showed a mixed germ-cell tumor.

Based on poor-risk characteristics, chemotherapy was started with an adequate clinical response.

Physicians should be aware of the potential complications of CS in the treatment of testicular cancer with high β-hCG levels since they could be associated with a rapidly progressive and high-volume disease.

Patients in this category should be referred to the centers experienced in the treatment of advanced germ-cell tumors.

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.