Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Testicular Choriocarcinoma Clinical Presentation

  • Author: Michael B Williams, MD, MS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
 
Updated: Apr 16, 2015
 

History

Unlike classic seminoma or mixed GCTs, pure choriocarcinoma is more likely to manifest as symptoms of metastatic disease and is the most common element observed in brain metastases.

The local tumor itself may be small and may not cause symptoms.

Next

Physical

The local tumor in choriocarcinoma may be small or nonpalpable, whereas most testicular GCTs cause scrotal swelling and a palpable mass. Testicular pain, with or without radiating pain to the groin and abdomen, is possible but is more consistent with epididymitis.

Widely metastatic testicular GCTs, including choriocarcinoma, may also manifest as a "burned-out" local testis lesion that consists of fibrous scar with absent or minute amounts of viable tumor.

Physical examination findings from lung, liver, and/or brain metastases may be more pronounced than an abnormal finding on testicular examination.

Previous
 
 
Contributor Information and Disclosures
Author

Michael B Williams, MD, MS Assistant Professor, Department of Urology, Leroy T Canoles, Jr, Cancer Research Center, Eastern Virginia Medical School

Michael B Williams, MD, MS is a member of the following medical societies: American Association for Cancer Research, American Urological Association, Society of Urologic Oncology, Texas Medical Association, American Society of Clinical Oncology, American Association of Clinical Urologists

Disclosure: Nothing to disclose.

Coauthor(s)

Paul F Schellhammer, MD Professor of Urology, Eastern Virginia Medical School; Urologist, Urology of Virginia, PC

Paul F Schellhammer, MD is a member of the following medical societies: American Medical Association, American Urological Association, Society of Surgical Oncology, Society of Urologic Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, Society of Laparoendoscopic Surgeons, Society of University Urologists, Association of Military Osteopathic Physicians and Surgeons, American Urological Association, Endourological Society

Disclosure: Nothing to disclose.

Additional Contributors

Leonard Gabriel Gomella, MD, FACS The Bernard W Godwin Professor of Prostate Cancer Chairman, Department of Urology, Associate Director of Clinical Affairs, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Leonard Gabriel Gomella, MD, FACS is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Urological Association, Sigma Xi, Society for Basic Urologic Research, Society of University Urologists, Society of Urologic Oncology

Disclosure: Received consulting fee from GSK for consulting; Received honoraria from Astra Zeneca for speaking and teaching; Received consulting fee from Watson Pharmaceuticals for consulting.

Acknowledgements

John W Davis, MD Assistant Professor, Department of Urology, University of Texas MD Anderson Cancer Center

John W Davis, MD is a member of the following medical societies: American College of Surgeons and American Urological Association

Disclosure: Nothing to disclose.

Dan Theodorescu, MD, PhD Paul A Bunn Professor of Cancer Research, Professor of Surgery and Pharmacology, Director, University of Colorado Comprehensive Cancer Center

Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology

Disclosure: Key Genomics Ownership interest Co-Founder-50% Stock Ownership; KromaTiD, Inc Stock Options Board membership

References
  1. Mostofi FK, Sesterhenn IA. Anatomy and pathology of testis cancer. Comprehensive Textbook of Genitourinary Oncology. Baltimore, Md: Williams and Wilkins; 1996.

  2. Chen X, Xu L, Chen X, Teng X, Zheng S. Testicular choriocarcinoma metastatic to skin and multiple organs. Two case reports and review of literature. J Cutan Pathol. 2010 Apr. 37(4):486-90. [Medline].

  3. Batata MA, Whitmore WF Jr, Chu FC. Cryptorchidism and testicular cancer. J Urol. 1980 Sep. 124(3):382-7. [Medline].

  4. Alvarado-Cabrero I, Hernández-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 Jan. 38(1):111-8. [Medline].

  5. Ramon y Cajal S, Pinango L, Barat A. Metastatic pure choriocarcinoma of the testis in an elderly man. J Urol. 1987 Mar. 137(3):516-9. [Medline].

  6. Berney DM, Warren AY, Verma M, Kudahetti S, Robson JM, Williams MW, et al. Malignant germ cell tumours in the elderly: a histopathological review of 50 cases in men aged 60 years or over. Mod Pathol. 2008 Jan. 21(1):54-9. [Medline].

  7. Klein EA. Tumor markers in testis cancer. Urol Clin North Am. 1993 Feb. 20(1):67-73. [Medline].

  8. Chieffi P. Recent advances in molecular and cell biology of testicular germ-cell tumors. Int Rev Cell Mol Biol. 2014. 312:79-100. [Medline].

  9. Bezan A, Gerger A, Pichler M. MicroRNAs in testicular cancer: implications for pathogenesis, diagnosis, prognosis and therapy. Anticancer Res. 2014 Jun. 34(6):2709-13. [Medline].

  10. Horstman WG. Scrotal imaging. Urol Clin North Am. 1997 Aug. 24(3):653-71. [Medline].

  11. Vugrin D, Cvitkovic E, Posner J. Neurological complications of malignant germ cell tumors of testis: biology of brain metastases (I). Cancer. 1979 Dec. 44(6):2349-53. [Medline].

  12. Bredael JJ, Vugrin D, Whitmore WF Jr. Autopsy findings in 154 patients with germ cell tumors of the testis. Cancer. 1982 Aug 1. 50(3):548-51. [Medline].

  13. Beahrs O, Henson D, Hutter R. Handbook for staging of cancer. The Manual of Staging Cancer. 4th ed. Philadelphia, Pa: JB Lippincott; 1993. 195-7.

  14. Prow DM. Germ cell tumors: staging, prognosis, and outcome. Semin Urol Oncol. 1998 May. 16(2):82-93. [Medline].

  15. Logothetis CJSamuels MLSelig DEOgden SDexeus FSwanson DJohnson Dvon Eschenbach A. Cyclic chemotherapy with cyclophosphamide, doxorubicin, and cisplatin plus vinblastine and bleomycin in advanced germinal tumors. Results with 100 patients. American Journal of Medicine. 2/1986. 81:219-28. [Medline].

  16. Tatokoro M, Kawakami S, Sakura M, Kobayashi T, Kihara K, Akamatsu H. Successful management of life-threatening choriocarcinoma syndrome with rupture of pulmonary metastatic foci causing hemorrhagic shock. Int J Urol. 2008 Mar. 15(3):263-4. [Medline].

  17. Bodiwala D, Summerton DJ, Terry TR. Testicular prostheses: development and modern usage. Ann Royal Coll Surg Engl. 2007. 89:349-53. [Medline]. [Full Text].

  18. Mead GM. Chemotherapeutic Management of Metastatic Germ Cell Testis Cancer. Risk-Adapted Therapy/Poor Risk Patients. Vogelzang et al, eds. Comprehensive Textbook of Genitourinary Oncology. 2nd ed. Philadelphia, Pa: Lippincott Williams & Williams; 2000. 1024-31.

  19. Requena L, Sanchez M, Aguilar A. Choriocarcinoma of the testis metastatic to the skin. J Dermatol Surg Oncol. 1991 May. 17(5):466-70. [Medline].

  20. Saxman SB, Loehrer PJ. Chemotherapeutic Management of Metastatic Germ Cell Testicular Cancer. Overview of Initial Therapy for Metastatic Seminoma and Nonseminoma. Vogelzang et al, eds. Comprehensive Textbook of Genitourinary Oncology. 2nd ed. Philadelphia, Pa: Lippincott Williams & Williams; 2000: 1010-7.

  21. Batata MA, Chu FC, Hilaris BS. Therapy and prognosis of testicular carcinomas in relation to TNM classification. Int J Radiat Oncol Biol Phys. 1982 Aug. 8(8):1287-93. [Medline].

  22. Lepidini G, Biancari F, D'Andrea V. Severe thrombosis after chemotherapy for metastatic choriocarcinoma of the testis maintaining complete remission for a long period. Scand J Urol Nephrol. 1997 Apr. 31(2):221-2. [Medline].

  23. Bosl GJ, Geller N, Cirrincione C. Interrelationships of histopathology and other clinical variables in patients with germ cell tumors of the testis. Cancer. 1983 Jun 1. 51(11):2121-5. [Medline].

  24. Stang A, Jansen L, Trabert B, Rusner C, Eberle A, Katalinic A, et al. Survival after a diagnosis of testicular germ cell cancers in Germany and the United States, 2002-2006: a high resolution study by histology and age. Cancer Epidemiol. 2013 Aug. 37(4):492-7. [Medline]. [Full Text].

  25. Azzopardi JG, Mostofi FK, Theiss EA. Lesions of the testes observed in certain patients with widespread choriocarcinoma and related tumors. Am J Pathol. 1961. 38:207-225.

  26. Fleming ID, Cooper JS, Henson DE, et al. AJCC Cancer Staging Manual. 5th ed. New York, NY: Lippincott-Raven; 1997.

  27. Kodama M, Murakami M, Kodama T. Chronological transition of the age-adjusted incidence rates (AAIRs) of 20 major neoplasias from early 1960s to mid-1980s. Anticancer Res. 1999 Jan-Feb. 19(1B):779-87. [Medline].

  28. Looijenga LH, Oosterhuis JW. Pathogenesis of testicular germ cell tumours. Rev Reprod. 1999 May. 4(2):90-100. [Medline].

  29. Parkin DM, Muir CS. Cancer Incidence in Five Continents. Comparability and quality of data. IARC Sci Publ. 1992. 45-173. [Medline].

  30. Richie JP. Neoplasms of the Testis. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders Co; 1998.

  31. Ro JY, Dexeus FH, el-Naggar A. Testicular germ cell tumors. Clinically relevant pathologic findings. Pathol Annu. 1991. 26 Pt 2:59-87. [Medline].

  32. Swerdlow AJ. Epidemiology of testicular cancer. Principles and Practice of Genitourinary Oncology. Philadelphia, Pa: Lippincott-Raven Publishers; 1997.

  33. Ulbright TM. Germ cell neoplasms of the testis. Am J Surg Pathol. 1993 Nov. 17(11):1075-91. [Medline].

Previous
Next
 
Testicular choriocarcinoma has multinucleated syncytiotrophoblastic cells that drape over smaller cytotrophoblastic cells, which together appear to form a border along a blood-filled villouslike space (upper right). Used with permission from Ernstoff MS, Heaney JA, and Peschel RE, eds. Testicular and Penile Cancer. Malden, Mass: Blackwell Science, Inc; 1998:20.
Table 1. Serum Tumor Markers (S)
SLDHHCG (mIU/mL)AFP (ng/mL)
SxNot assessedNot assessedNot assessed
S0≤N*andNormalandNormal
S1< 1.5 x Nand< 5000and< 1000
S21.5-10 x Nor5000-50,000or1000-10,000
S3>10 x Nor>50,000or>10,000
*N=upper limit of reference range for the LDH assay
Table 2. Stage Grouping
Stage groupingTNMS
Stage 0pTisN0M0S0
Stage IT1-T4N0M0Sx
Stage IAT1N0M0S0
Stage IBT2-4N0M0S0
Stage ISAny TN0M0S1-S3
Stage IIAny TAny NM0Sx
Stage IIAAny TN1M0S0-S1
Stage IIBAny TN2M0S0-S1
Stage IICAny TN3M0S0-S1
Stage IIIAny TAny NM1Sx
Stage IIIAAny TAny NM1aS0-S1
Stage IIIBAny TAny NM0-M1aS2
Stage IIICAny TAny NM0-M1aS3
Any TAny NM1bAny S
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.