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Organo Oficial de la Sociedad Mexicana de Urología

2009, Number 4

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Rev Mex Urol 2009; 69 (4)

Massive digestive tract hemorrhage as initial manifestation of metastatic testicular choriocarcinoma

Urdiales-Ortiz A, Fulda-Graue S, Pérez-Becerra R, Santana-Ríos Z, Hernández-Castellanos V, Merayo-Chalico C, Sánchez-Turati G, Camarena-Reynoso H, Leos-Acosta C, Shuck-Bello C, Vázquez-Ortega L, Cantellano-Orozco M, Arellano RH, Escudero-Mendoza E, Parraguirre-Martínez S, Morales-Montor J, Pacheco-Gahbler C, Calderón-Ferro F

Language: Spanish
References: 13
Page: 163-166
PDF size: 387.06 Kb.


ABSTRACT

Clinical case: The patient is a 32-year-old man who sought medical attention at our institution for massive hemorrhage of the upper digestive tract diagnosed through endoscopy and angiography. He was taken to the operating room and during surgery a non-resectable retroperitoneal mass invading duodenum and large vessels was found. Postoperative diagnosis was metastatic testicular choriocarcinoma and patient underwent radical orchiectomy and received chemotherapy. At 18-month follow-up, tumor markers and imaging studies were negative for tumor activity.
Discussion: Five to ten percent of testicular tumors present with clinical manifestations deriving from metastatic disease. Only 5% of metastatic tumors affect the gastrointestinal tract and non-seminomatous germ cell tumors are more frequent, especially choriocarcinoma.
Conclusions: Gastrointestinal hemorrhage is an indicator of poor prognosis in these patients and in severe cases must be treated with endoscopy, angiography, and in select cases, surgery.
Metastatic testicular germ cell tumors should be included in differential diagnosis of gastrointestinal tract tumors in young men.


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