Testicular Choriocarcinoma Clinical Presentation

Updated: Sep 07, 2019
  • Author: Michael B Williams, MD, MS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Unlike classic seminoma or mixed germ cell tumors (GCTs), pure choriocarcinoma of the testis is less likely to produce localized findings and more likely to manifest with signs and symptoms of metastatic disease—in particular, brain metastases. In male patients with metastatic foci from an unknown primary, the possibility of testicular choriocarcinoma should be kept in the differential diagnosis. [15]

The most frequent sites of metastases are lung, liver, brain, gastrointestinal tract, spleen, and adrenal glands. Although rare, cutaneous metastasis of testicular choriocarcinomas have been reported as angiomas, pyogenic granulomalike tumors, hemorrhagic nodules, or nontender subcutaneous nodules. In one report, the initial presentation of pure testicular choriocarcinoma was a hemorrhagic nodule on the lip, and the diagnosis was made only after histologic examination. [16]

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

Choriocarcinoma syndrome is a rare complication that occurs in patients with metastatic choriocarcinoma and markedly elevated levels of beta–human chorionic gonadotropin (beta-hCG). [17, 18]  The syndrome most often develops shortly after the initiation of chemotherapy, but cases of choriocarcinoma syndrome as the initial presentation of testicular cancer have been reported. [19] The syndrome is characterized by hemorrhage from metastases and is characterized by acute hemorrhage from metastates. Any site may be involved but bleeding from lung metastases is typical; patients may present with dry cough or hemoptysis, which may progress to acute respiratory failure. The syndrome is life-threatening and requires immediate treatment. [20, 21]





Physical Examination

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.