Choriocarcinoma Syndrome as an Initial Presentation ofTesticular Cancer

Choriocarcinoma syndrome (CS) is a rare clinical entity within the spectrum of nonseminomatous germ-cell tumors (NSGCT). Itis characterized by the abrupt establishment of rapidly progressive and hemorrhagic tumors associated with very high levels of thebeta fraction of human chorionic gonadotropin (β-hCG) and with a very poor prognosis, particularly in patients withβ-hCGvalues above 50,000 IU/L. We present the case of a 17-year-old man with a sudden onset nonmassive hemoptysis. Physicalexamination revealed a right testicular mass. Imaging studies showed metastatic lung, bone, and retroperitoneal disease.β-hCGserum levels were 222,493.21 IU/L, AFP 1.56 ng/mL, and DHL 457 IU/L. Histopathological study after right radicalorchiectomy showed a mixed germ-cell tumor. Based on poor-risk characteristics, chemotherapy was started with an adequateclinical response. Physicians should be aware of the potential complications of CS in the treatment of testicular cancer withhighβ-hCG levels since they could be associated with a rapidly progressive and high-volume disease. Patients in this categoryshould be referred to the centers experienced in the treatment of advanced germ-cell tumors. Due to the severity of thepresentation, hemodynamic monitoring, ideally in an intensive care unit, is essential as well as timely administration ofcytotoxic treatment.