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Testicular Choriocarcinoma

Testis Choriocarcinoma


Presentation

  • His presentation suggested chronic, rather than acute, gastrointestinal blood loss.[ncbi.nlm.nih.gov]
  • A case of testicular choriocarcinoma in a 24-year-old man who presented for the first time with metastatic neck mass is reported here.[ncbi.nlm.nih.gov]
  • The mean age at presentation was 25.5 years. Neurologic symptoms accounted for the initial presentation of 9 patients (60%). Outcomes were predominantly poor, with 10 patients (67%) expiring shortly after their initial diagnosis.[ncbi.nlm.nih.gov]
  • The present case highlights that testicular choriocarcinoma metastatic to the skin should be included in the differential of cutaneous scalp tumors.[ncbi.nlm.nih.gov]
  • In this study we present a case of testicular choriocarcinoma, who presented with abdominal pain, cough, generalized weakness and left sided cervical mass. Incisional biopsy of cervical mass was performed.[ncbi.nlm.nih.gov]
Inguinal Lymphadenopathy
  • Physical exam was significant for 9 x 6 centimetre’s mass in the left testis with normal right testis and no inguinal lymphadenopathy. Visual acuity in right eye was 20/20 and left eye was 20/800.[article.sapub.org]
Hypoxemia
  • CT angiogram was performed to evaluate for pulmonary embolism (PE), which demonstrated a singular, small left lower lobe PE, determined to be an unlikely contributor to his profound hypoxemia [Figure 3].[urologyannals.com]
  • Refractory hypoxemia and ventilator-associated pneumonia were the leading cause of death.[frontiersin.org]
Soft Tissue Mass
  • CT scan shows soft tissue mass in the right hemimandible area. Excision of the right sided intraoral buccal mass and right sided hemimandibulectomy was done. Histopathological examination reveals testicular choriocarcinoma.[omicsonline.org]
Constitutional Symptom
  • Conclusions Choriocarcinoma should be considered as one of the differentials in otherwise healthy young males who present with visual abnormalities and constitutional symptoms.[article.sapub.org]
Lower Abdominal Pain
  • A 33‐year‐old man with a history of undescended testes as a child initially presented with constipation and lower abdominal pain for 1 year.[shmabstracts.com]
Early Satiety
  • He was treated for presumed irritable bowel syndrome, but his symptoms progressed to early satiety and abdominal fullness. He subsequently developed dysphagia, hemoptysis, and left groin pain. A chest X‐ray revealed mediastinal widening.[shmabstracts.com]
Dysphagia
  • He subsequently developed dysphagia, hemoptysis, and left groin pain. A chest X‐ray revealed mediastinal widening. A subsequent computerized tomography scan of the chest revealed a large 7   8‐cm mediastinal mass with multiple lymph nodes.[shmabstracts.com]
Abdominal Fullness
  • He was treated for presumed irritable bowel syndrome, but his symptoms progressed to early satiety and abdominal fullness. He subsequently developed dysphagia, hemoptysis, and left groin pain. A chest X‐ray revealed mediastinal widening.[shmabstracts.com]
Upper Abdominal Pain
  • A 54-year-old male presented with a 2-month history of progressive upper abdominal pain, weight loss, and jaundice.[nature.com]
Eye Pain
  • The patient denied any flashes, eye pain, redness, discharge or headache. He denied any history of Human immunodeficiency virus (HIV), other sexually transmitted diseases, trauma to testis, history of cryptorchidism or family history of cancer.[article.sapub.org]
Subcutaneous Nodule
  • nodule was performed and showed good cellularity with many tight clusters composed of mononuclear cells with large hyperchromatic nuclei and several distinct nucleoli.[ijpmonline.org]
  • The patient subsequently developed several clustered erythematous-violaceous firm subcutaneous nodules without ulceration or other epidermal changes on the zygoma, with a larger nodule on the anterior neck and right posterior shoulder.[ncbi.nlm.nih.gov]
Subcutaneous Mass
  • These cases, although very rare, can be a great diagnostic and therapeutic challenge and should be considered in the differential diagnosis of subcutaneous masses occurring in young males.[ncbi.nlm.nih.gov]
Flat Affect
  • On physical examination, the patient had a flat affect, was slow to respond, and was acting unusual.[ncbi.nlm.nih.gov]
Tremor
  • He also reported palpitations, a 16‐pound weight loss, and tremors. Thyroid‐stimulating hormone was 0.02, and free T4 was 2.82. Beta‐HCG levels were greater than 200,000 IU/L.[shmabstracts.com]
Irritability
  • He was treated for presumed irritable bowel syndrome, but his symptoms progressed to early satiety and abdominal fullness. He subsequently developed dysphagia, hemoptysis, and left groin pain. A chest X‐ray revealed mediastinal widening.[shmabstracts.com]
Altered Mental Status
  • Magnetic resonance imaging (MRI) of the brain was ultimately performed for questionable altered mental status and revealed a small enhancing lesion [Figure 1] c. Figure 1: Testicular choriocarcinoma. Preoperative imaging.[urologyannals.com]
Testicular Mass
  • The histopathological assessment of the biopsied tissue, in combination with elevated serum β-HCG levels and presentation of testicular mass, indicated primary testicular choriocarcinoma with cutaneous and systemic metastasis.[ncbi.nlm.nih.gov]
  • In order to be able to treat these patients appropriately, a provider must recognize characteristic features of choriocarcinoma including elevated human chorionic gonadotropin in a young man with testicular mass; the astute clinician should also know[mayoclinic.pure.elsevier.com]
  • Testicular ultrasound confirmed a left testicular mass.[acgcasereports.gi.org]
  • Although chemotherapy may result in disappearance of the testicular mass, orchiectomy is always indicated for accurate diagnosis.[article.sapub.org]
  • Ultrasonography shows right testicular mass, para-aortic lymphadenopathy and multiple hepatic SOL. CT scan shows soft tissue mass in the right hemimandible area.[omicsonline.org]

Workup

  • Postdiagnostic workup of an NSGCT includes chest/abdominal/pelvic computed tomography, repeat bHCG, LDH, and AFP levels, and brain MRI if indicated.[urologyannals.com]
  • Therefore, serum markers for germ cell tumors should be sent as part of the initial workup for men in this age range presenting with metastatic disease.[surgicalneurologyint.com]
  • Postoperative details are as follows: Radical orchiectomy is usually an outpatient procedure or is performed as a 23-hour admission, often accompanied by the staging workup.[emedicine.medscape.com]
  • Review Topic QID: 106375 5 No further workup, instruct patient to return if symptomatic M1 Select Answer to see Preferred Response PREFERRED RESPONSE 2 Sorry, this question is for PEAK Premium Subscribers only ARTICLES (4) VIDEOS (1) Topic COMMENTS (12[medbullets.com]
  • He was sent to his primary care physician for a physical exam and a coagulability workup. The physical exam failed to provide any additional information, and the coagulability workup was negative.[retinalphysician.com]

Treatment

  • Choriocarcinoma is a unique and aggressive germ cell malignancy, and these patients require early aggressive treatment to improve their chance of survival.[mayoclinic.pure.elsevier.com]
  • Treatment options include orchiectomy /- combination chemotherapy. choriocarcinoma testicular germ cell tumors Promoted articles (advertising)[radiopaedia.org]
  • Treatment Outcome Treatment Approaches Without a Reduced-Dose Intensity During Induction Chemotherapy There is no effective preventive precaution against the choriocarcinoma syndrome.[frontiersin.org]
  • Clinical pathological, radiographic, treatment, and outcome data were retrospectively reviewed and descriptive statistical analysis was performed.[ascopubs.org]

Prognosis

  • Skin metastasis is very rare but portends a grave prognosis when diagnosed. We present the case of a 24-year-old white male with a testicular mixed germ-cell tumor with skin metastases of choriocarcinoma.[ncbi.nlm.nih.gov]
  • It is concluded that in males, choriocarcinoma carries a very dismal prognosis and a very poor response to chemotherapy and radiotherapy; surgery has no role in the management.[ncbi.nlm.nih.gov]
  • Review of the literature indicates that skin metastasis of choriocarcinoma usually occurs as a nodular lesion with the histologically typical feature of the primary disease and signals of poor prognosis.[ncbi.nlm.nih.gov]
  • Although its prognosis has improved with the development of cisplatin-based chemotherapy regimens, cerebral metastases are prone to hemorrhage and associated with high morbidity.[ncbi.nlm.nih.gov]
  • While 5-year overall survival and cure for this population is greater than 95 %, choriocarcinoma is an aggressive subtype of this disease with far worse prognosis—5-year survival for choriocarcinoma is less than 80 %.[mayoclinic.pure.elsevier.com]

Etiology

  • (Etiology) The cause of Choriocarcinoma of the Testis is unknown.[dovemed.com]
  • Pathophysiology and Etiology Choriocarcinoma recapitulates placental tissue development.[emedicine.medscape.com]
  • Authors hypothesized multifactorial etiology of ARDS in this super-high-risk group of patients and the clinical presentation was compatible to the choriocarcinoma syndrome reported by Logothetis ( 9 ).[frontiersin.org]
  • Epidemiologic, etiologic, and pathologic features. Cancer. 1973, 32: 1186-1201. 10.1002/1097-0142(197311)32:5 3.0.CO;2-8. 4. von Hochstetter AR, Hedinger CE: The differential diagnosis of testicular germ cell tumors in theory and in practice.[jmedicalcasereports.biomedcentral.com]

Epidemiology

  • […] background. large multinucleated cells with smudged nuclear chromatin (syncytiotrophoblast) syncytiotrophoblasts form a "cap" around clusters of cytotrophoblasts hemorrhagic and necrotic foci residual scar as the only evidence of prior existence of the tumor Epidemiology[humpath.com]
  • National Cancer Institute – Surveillance, Epidemiology and End Results Program. Available from: . [Last retrieved on 2017 Nov 28]. 5. Reilley MJ, Pagliaro LC. Testicular choriocarcinoma: A rare variant that requires a unique treatment approach.[urologyannals.com]
  • […] common in Hispanics compared to Asian and black populations in the US References: [1] [2] [3] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • The epidemiology of testicular cancer in young adults. Am J Epidemiol 1980 ; 112 : 232 – 46. 2. Wingo, PA, Tong, T, Bolden, S. Cancer statistics, 1995. CA Cancer J Clin 1995 ; 45 : 8 – 30. 3. Mostofi, FK.[cambridge.org]
  • Other risks include the following: Maternal estrogen exposure Epidemiology United States Testicular GCTs are rare, representing only 1%-2% of all malignancies in males and occurring in 1 of 250 men by age 65 years.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • It brings together the pathophysiology of disease with detailed clinical guidance on diagnosis and management for the full range of childhood cancers, including aspects important in optimal supportive care.[books.google.de]
  • Pathophysiology and Etiology Choriocarcinoma recapitulates placental tissue development.[emedicine.medscape.com]
  • Pathophysiology The exact pathogenesis of choriocarcinoma syndrome is currently unknown.[frontiersin.org]
  • Epidemiology : usually develop after the age of 4 Pathophysiology : produces amounts of testosterone and a small amount of estrogen, progesterone, and corticosteroids testosterone excess causes precocious puberty in males (and masculinization in females[amboss.com]

Prevention

  • Treatment Outcome Treatment Approaches Without a Reduced-Dose Intensity During Induction Chemotherapy There is no effective preventive precaution against the choriocarcinoma syndrome.[frontiersin.org]
  • Transplantation Substance Use and Addiction Surgery Surgical Innovation Surgical Pearls Teachable Moment Technology and Finance The Rational Clinical Examination Tobacco and e-Cigarettes Toxicology Trauma and Injury Treatment Adherence United States Preventive[jamanetwork.com]
  • Removal of the testis Debulking surgery to reduce tumor size, followed by chemotherapy Clotting the vessels in the tumor (embolization) Chemotherapy Radiotherapy Undertaking treatment of underlying conditions How can Choriocarcinoma of the Testis be Prevented[dovemed.com]
  • Prevention It’s not possible to prevent testicular cancer since most of the risk factors (young age, undescended testicles, being white, etc.) cannot be changed or controlled.[urmc.rochester.edu]
  • Prevention There is no known means of prevention. However, early detection of the symptoms and prompt medical treatment can improve the odds of survival. KEY TERMS Biopsy — A sample of an organ taken to look for abnormalities.[encyclopedia.com]

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