Gastrointestinal hemorrhage and gynecomastia as first signs of metastatic testicular choriocarcinoma

Abstract

Testicular choriocarcinoma is an infrequent non seminomatous germ cell tumor, usually presenting histologically as part of a mixed germ cell tumor, and rarely as pure form. It metastasizes early, usually along hematogenous routes, lungs being the most frequent sites of metastasis. Involvement of the gastro-intestinal tract as metastatic site is extremely uncommon and rarely described in the literature. We report the case of a 47 year-old male with gastric and pulmonary metastases from testicular mixed germ cell tumor mainly represented by choriocarcinoma as histological subtype, presenting with melena and gynecomastia as first clinical signs. Morphological and immunohistochemical analyses of biopsies taken from the endoscopically identified gastric hemorrhagic lesion and from lung nodules showed undifferentiated neoplastic epithelial cells in a necrotic and hemorrhagic background. Coexistence of gynecomastia addressed towards an hormonal-dependent tumor and prompted us to apply further morphological and immunohistochemical analyses, revealing the gonadal primary neoplasm, subsequently confirmed at surgery.