Testicular Choriocarcinoma Metastasizing to the Small Bowel Causing Intussusception: Case Report
Introduction
Testicular cancers are divided into germ cell tumors (GCT) and non-germ cell tumors. Testicular germ cell tumors (TGCT) are the most frequent malignancy among young men although they are uncommon among general population [1]. There are recent evidences that the incidence of TCGT TGCTs is are increasing among Hispanic men with an expected increase over the next decade [2]. Germ cell tumors are either seminomas or non-seminomas (NSGCT) [3]. Testicular choriocarcinoma is a highly aggressive vascular germ cell tumor with trophoblastic differentiation [4]. It is usually detected as a component of the mixed malignant germ cell tumors. However, in a pure form, it is exceedingly rare and compromise only 0.2–0.6% of all testis tumors [5].
Testicular choriocarcinoma is characterized by its early hematogenous and lymphatic spread, with frequent metastasis to the central nervous system, lungs, bone, liver, and lymph nodes. It usually presents with symptoms related to metastases rather...
Notes
Funding
The authors received no financial support for the research, authorship, and publication of this article.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
References
- 1.Calaminus G, Joffe J. Germ cell tumors in adolescents and young adults. Prog Tumor Res. 2016;43:115–27.CrossRefGoogle Scholar
- 2.Ghazarian AA, Kelly SP, Altekruse SF, Rosenberg PS, McGlynn KA. Future of testicular germ cell tumor incidence in the United States: forecast through 2026. Cancer. 2017;123(12):2320–8.CrossRefGoogle Scholar
- 3.Chieffi P, Chieffi S, Franco R, Sinisi AA. Recent advances in the biology of germ cell tumors: implications for the diagnosis and treatment. J Endocrinol Investig. 2012;35(11):1015–20.Google Scholar
- 4.Alvarado-Cabrero I, Hernandez-Toriz N, Paner GP. Clinicopathologic analysis of choriocarcinoma as a pure or predominant component of germ cell tumor of the testis. Am J Surg Pathol. 2014;38(1):111–8.CrossRefGoogle Scholar
- 5.Humphrey PA. Choriocarcinoma of the testis. J Urol. 2014;192(3):934–5.CrossRefGoogle Scholar
- 6.Hoffman HA, Toshkezi G, Fullmer JM, Hall W, Chin LS. Pitfalls in diagnosis and management of testicular choriocarcinoma metastatic to the brain: report of 2 cases and review of literature. World Neurosurg. 2017;106:536–42.CrossRefGoogle Scholar
- 7.Molina Infante J, Beceiro Pedreno I, Ripoll Noiseux C, Marin Jimenez I, Gonzalez Asanza C, Menchen Fernandez-Pacheco P. Gastrointestinal hemorrhage due to metastatic choriocarcinoma with gastric and colonic involvement. Rev Esp Enferm Dig. 2004;96(1):77–80.CrossRefGoogle Scholar
- 8.Cho EB, Byun JM, Jeong DH, Yoon HK, Kim YN, Sung MS. Metastatic choriocarcinoma as initial presentation of small bowel perforation in absence of primary uterine lesion: a case report. Tumori 2016;102(Suppl. 2).CrossRefGoogle Scholar
- 9.Yokoi K, Tanaka N, Furukawa K, Ishikawa N, Seya T, Horiba K, et al. Male choriocarcinoma with metastasis to the jejunum: a case report and review of the literature. J Nippon Med Sch. 2008;75(2):116–21.CrossRefGoogle Scholar
- 10.Winter C, Albers P. Testicular germ cell tumors: pathogenesis, diagnosis and treatment. Nat Rev Endocrinol. 2011;7(1):43–53.CrossRefGoogle Scholar
- 11.Wang L, Pitman MB, Castillo CF, Dal Cin P, Oliva E. Choriocarcinoma involving the pancreas as first manifestation of a metastatic regressing mixed testicular germ cell tumor. Mod Pathol. 2004:17(12)1573–80.CrossRefGoogle Scholar
- 12.Baagar K, Khan FY, Alkuwari E. Choriocarcinoma syndrome: a case report and a literature review. Case Rep Oncol Med. 2013;2013:697251.PubMedPubMedCentralGoogle Scholar
- 13.Zerbib P, Prieur E, Khoury-Helou A, Catala P, Pruvot FR, Chambon JP. Hemorrhagic digestive metastases from testicular choriocarcinoma. Ann Chir. 2002;127(4):300–1.CrossRefGoogle Scholar
- 14.Odelowo OO, Naab T, Dewitty RL. Metastatic choriocarcinoma presenting as a bleeding duodenal ulcer. J Assoc Acad Minor Phys. 2001;12(3):144–8.PubMedGoogle Scholar
- 15.Rosenblatt GS, Walsh CJ, Chung S. Metastatic testis tumor presenting as gastrointestinal hemorrhage. J Urol. 2000;164(5):1655.CrossRefGoogle Scholar
- 16.Hsu CC, Chen JJ, Changchien CS. Endoscopic features of metastatic tumors in the upper gastrointestinal tract. Endoscopy. 1996;28(2):249–53.CrossRefGoogle Scholar
- 17.Harada N, Misawa T, Chijiiwa Y, Imazono Y, Fujishima H, Nawata H. A case of extragenital choriocarcinoma in the jejunum. Am J Gastroenterol. 1991;86(8):1077–9.PubMedGoogle Scholar
- 18.Nkanza NK, King CS. Choriocarcinoma presenting as an intussusception--a case report. Cent Afr J Med. 1989;35(4):389–92.PubMedGoogle Scholar
- 19.Ramessur A, Openshaw M, Sarwar N. Intussusception in gestational choriocarcinoma (not histologically proven), resolving spontaneously with chemotherapy. BMJ Case Rep 2015;2015.Google Scholar
- 20.Popov I, Muckart D, Moodley J. Choriocarcinoma presenting with upper gastrointestinal bleeding and intussusception. S Afr J Surg. 2003;41(3):70–1.PubMedGoogle Scholar
- 21.Martinez-Ordaz JL, Gomez-Jimenez LM, Ballinas-Oseguera G. Jejunal metastasis from choriocarcinoma. A three-case report. Rev Gastroenterol Mex. 2012;77(3):143–7.PubMedGoogle Scholar
- 22.Ji YI, Jung MH. Gastrointestinal bleeding caused by ileal metastasis of a tubal complete mole: a case report. J Women’s Health (Larchmt). 2010;19(6):1217–20.CrossRefGoogle Scholar
- 23.Bain AJ, Owens DJ, Savides TJ. Image of the month. Upper gastrointestinal bleeding caused by metastatic testicular choriocarcinoma. Clin Gastroenterol Hepatol. 2010;8(4):A22.CrossRefGoogle Scholar
- 24.Armellino MF, Ambrosino F, Forner AL, de Stefano G, Robustelli U, Scardi F, et al. Jejunal perforation from metastatic choriocarcinoma. Case report and review of the literature. G Chir. 2008;29(4):145–8.PubMedGoogle Scholar
- 25.Palomeque A, Muffak K, Ramia JM, Mansilla A, Garcia-Navarro A, Ferron JA. Gastrointestinal bleeding and intestinal invagination due to intestinal choriocarcinoma. Cir Esp. 2005;78(1):59.CrossRefGoogle Scholar
- 26.Oge O, Daphan C, Ozen H, Ayhan A. Intestinal testis tumor metastasis as a cause of intussusception: a case report. Int Urol Nephrol. 2000;32(1):93–4.CrossRefGoogle Scholar
- 27.Hofflander R, Beckes D, Kapre S, Matolo N, Liu S. A case of jejunal intussusception with gastrointestinal bleeding caused by metastatic testicular germ cell cancer. Dig Surg. 1999;16(5):439–40.CrossRefGoogle Scholar
- 28.Lowe K, Paterson J, Armstrong S, Walsh S, Groome M, Mowat C. Metastatic testicular choriocarcinoma: a rare cause of upper GI bleeding. ACG Case Rep J. 2015;3(1):36–8.CrossRefGoogle Scholar
- 29.Bruce S, Sorosky J. Gestational trophoblastic disease. In: StatPearls. Treasure Island (FL)2017.Google Scholar