Testicular Choriocarcinoma 

  • Author: Michael B Williams, MD, MS; Chief Editor: Bradley Fields Schwartz, DO, FACS   more...
 
Updated: Jan 20, 2012
 

Background

Pure choriocarcinoma of the testis is the exception to most of the rules established for testicular seminoma and all other forms of nonseminomatous germ cell tumors (NSGCTs). Like other germ cell tumors (GCTs), choriocarcinoma typically affects younger men. Unlike other cancers, choriocarcinoma metastasizes hematogenously, with the testicular primary tumor often small or even "burned-out." In most reports, the tumor responds poorly to radiation and chemotherapy and carries high mortality rate. Surgery is usually limited to radical orchiectomy for tissue diagnosis.[1]

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Pathophysiology

Choriocarcinoma recapitulates placental tissue development. For unknown reasons, it metastasizes early via hematogenous routes to the lung, liver, and brain, among others.[1, 2]

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Epidemiology

Frequency

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. However, these tumors represent the most common malignancy in men aged 15-35 years. The incidence rates are 3.7 cases and 0.9 cases per 100,000 per year in white males and black males, respectively. GCTs have several subtypes and frequencies, including seminoma (40%), embryonal tumor (25%), teratocarcinoma (25%), teratoma (5%), and choriocarcinoma (pure; 1%).

International

The incidence of testis cancer increased worldwide from the early 1960s to the mid 1980s. The malignancy is more common in whites than in nonwhites. The highest rates are in Denmark (8.4 cases per 100,000 per y) and Switzerland (6.2-8.8 cases per 100,000 per y), and the frequency varies across Europe. Because of its rare incidence, the international rates of pure choriocarcinoma are unknown.

Race

No racial differences in choriocarcinoma have been reported.

Age

Ramon y Cajal et al (1987) reported a case of pure choriocarcinoma in the oldest patient recorded, aged 63 years.[3] The patient died of aspiration shortly after initiation of chemotherapy, so a determination of treatment efficacy in this age group was impossible. The second-oldest patient reported was aged 50 years.

In a literature review of 10,000 cases of germinal testicular cell tumors, Ramon y Cajal et al found 54 (0.5%) cases of pure choriocarcinoma. The tumors occurred most commonly in men aged 20-30 years.[3]

In a 2008 review of 50 men older than 60 years with GCT, only one was found to have a component of choriocarcinoma.[4]

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Contributor Information and Disclosures
Author

Michael B Williams, MD, MS  Assistant Professor, Department of Urology, Eastern Virginia Medical School

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

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 is a member of the following medical societies: American Medical Association, American Urological Association, Society of Surgical Oncology, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

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.

Specialty Editor Board

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, and Society of Urologic Oncology

Disclosure: GSK Consulting fee Consulting; Astra Zeneca Honoraria Speaking and teaching; Watson Pharmaceuticals Consulting fee Consulting

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

Disclosure: Medscape Salary Employment

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

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

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, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

References

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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
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