Hémoptysie révélant une métastase endobronchique d’un choriocarcinome testiculaire

Case report: A case with atypical presentation oftesticular choriocarcinoma

Testicular choriocarcinoma is a relatively rare malignancy with a highly aggressive nature. Timely diagnosis and treatment can help prolong the survival of patients and even cure them. This case reports a 29-year-old male who presented to the clinic for a month with epigastric pain. On examination, a massive mass of approximately 9*10 cm could be palpated in the upper abdomen. When asked about his previous history, the patient only described a history of a right inguinal hernia that had been repaired 12 years earlier. The admission diagnosis was considered the retroperitoneal tumor, which was found to have metastasized to the liver and lungs after the completion of relevant tests. We then performed a CT-guided lune puncture biopsy on day 8 of admission. The biopsy pathology suggested metastatic cancer was considered. As the symptoms of tumor compression gradually worsened, we performed surgical treatment (retroperitoneal tumor resection + partial duodenal resection + enteroanastomosis) on day 13 of admission. The postoperative pathology was choriocarcinoma. We subsequently conducted a detailed inquiry with the patient's family about his medical history and found a history of inguinal testicle. Through testicular ultrasound examination, it was preliminarily determined to be testicular choriocarcinoma (not yet pathologically confirmed). We wanted to start salvage chemotherapy as soon as possible after surgery. However, the patient's postoperative condition was poor, with rapid progression of hepatopulmonary metastases and gradually increased thyrotoxicosis, and we started salvage chemotherapy (EP regimen: etoposide and cisplatin) on postoperative day 12. However, the patient was forced to stop due to a severe chemotherapy reaction and died of respiratory and cardiac arrest in the hospital. For male patients with retroperitoneal mass, the possibility of germ-cell neoplasm should first be excluded. By inquiring in detail about a history of cryptorchidism and in the initial days of hospitalization, testicular exploration, ultrasounds, and serum tumor markers (AFP, β-HCG) tests can be conducted to rule out the possibility of germ-cell neoplasm, thereby preventing misdiagnosis and treatment delays. If the clinical diagnosis is metastatic germ-cell tumor with severe symptoms of metastatic disease, surgery should never be used as the initial treatment.

Hemoptysis as primary manifestation in three women with choriocarcinoma with pulmonary metastasis: a case series

Background

Gestational choriocarcinoma is the most common gestational trophoblastic neoplasia; it is often secondary to hydatidiform mole, as well as to abortion, ectopic pregnancy, premature delivery, or term delivery. Approximately 60% of patients with choriocarcinoma develop pulmonary metastases, but for patients with a respiratory condition, choriocarcinoma with lung metastasis is a relatively rare lung cancer diagnosis. Three cases of choriocarcinoma with pulmonary metastasis who had the primary symptom of hemoptysis are described.

Case presentation

This case report describes a 35-year-old Chinese woman of Han nationality, a 23-year-old Chinese woman of Han nationality, and a 46-year-old Chinese woman of Han nationality whose primary symptom was hemoptysis and different chest imaging manifestations; they were finally diagnosed as having pulmonary metastatic choriocarcinoma. All patients had low risk factors, including abortion, hydatidiform mole, and ectopic pregnancy. Human chorionic gonadotropin played an important role in choriocarcinoma diagnosis.

Conclusions

Based on the diagnosis and treatment of the three patients, we suggested that for women with pregnancy history and hemoptysis (particularly in the presence of risk factors such as abortion, hydatidiform mole, ectopic pregnancy, and >35-years old), choriocarcinoma may be the possible diagnosis or at least the main differential diagnosis.