Recurrence of Germ Cell Testicular Tumor Presenting with Choriocarcinoma Syndrome and Acute Pancreatitis

Yıl 2025, Cilt: 16 Sayı: 2, 53 - 55, 29.06.2025

Handan Özen Olcay , Emine Emektar , Yunsur Çevik

Öz

Abstract
Introduction: Choriocarcinoma syndrome (CS), characterized by pulmonary hemorrhage, widespread metastases, and markedly elevated beta-human chorionic gonadotropin levels, poses significant challenges in both diagnosis and treatment.
Case report: In this case report, we present a rare case of recurrent mixed germ cell testicular tumor presenting to the emergency department with acute respiratory distress syndrome (ARDS) secondary to CS and pancreatitis.
Conclusion: CS is a rare but highly fatal syndrome, often arising as a complication of advanced-stage germ cell tumors.
Since these patients primarily present to emergency departments, it is crucial for emergency physicians to consider CS in the differential diagnosis when young male patients with a history of testicular tumors present with acute respiratory distress, hemoptysis, abdominal pain, or symptoms resembling pancreatitis.
References
1. Nauman M, Leslie SW. Nonseminomatous Testicular Tumors. 2023 Aug 14. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 33760513.
2. Xiao QF, Li J, Tang B, Zhu YQ. Testicular mixed germ cell tumor: A case report. World J Clin Cases. 2023 Oct 6;11(28):6902-6907. doi: 10.12998/wjcc.v11.i28.6902.
3. Rejlekova K, Cursano MC, De Giorgi U, Mego M. Severe Complications in Testicular Germ Cell Tumors: The Choriocarcinoma Syndrome. Front Endocrinol (Lausanne). 2019 Apr 12;10:218. doi: 10.3389/fendo.2019.00218.
4. Zeitjian VS, Arslan W, Borja-Alvarez A, Amar S. Choriocarcinoma Syndrome: A Potentially Fatal Complication of Testicular Cancer. Case Rep Oncol Med. 2019 Feb 24;2019:4092941. doi: 10.1155/2019/4092941.
5. Magudia K, Menias CO, Bhalla S, Katabathina VS, Craig JW, Hammer MM. Unusual Imaging Findings Associated with Germ Cell Tumors. Radiographics. 2019 Jul-Aug;39(4):1019-1035. doi: 10.1148/rg.2019180050.
6. Trpchevska EN, Todorovska B, Todorovska MB, Trajkovska M, Nikolova D, Dzambaz D, et al. Testicular Mixed Germ Cell Tumor Presenting with Upper Gastrointestinal Bleeding: A Case Report. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2023 Jul 15;44(2):47-52. doi: 10.2478/prilozi-2023-0024.
7. Tannous T, Miskovsky J, Keating M. Testicular Germ Cell Tumors: Paraneoplastic Syndromes and the Role of Beta-Human Chorionic Gonadotropin. Cureus. 2021 Apr 4;13(4):e14286. doi: 10.7759/cureus.14286.
8. Soputro NA, Roberts J, Wong S, Dias BH. Pretreatment of choriocarcinoma syndrome: a rare complication of metastatic germ cell tumours. BMJ Case Rep. 2022 Mar 2;15(3):e248172. doi: 10.1136/bcr-2021-248172. PMID: 35236696; PMCID: PMC8895934.
9. Kandori S, Kawai K, Fukuhara Y, Joraku A, Miyanaga N, Shimazui T, et al. A case of metastatic testicular cancer complicated by pulmonary hemorrhage due to choriocarcinoma syndrome. Int J Clin Oncol. 2010 Dec;15(6):611-4. doi: 10.1007/s10147-010-0092-3.
10. Agrawal T, Blau AJ, Chwals WJ, Tischler AS. A Unique Case of Mediastinal Teratoma with Mature Pancreatic Tissue, Nesidioblastosis, and Aberrant Islet Differentiation: a Case Report and Literature Review. Endocr Pathol. 2016 Mar;27(1):21-4. doi: 10.1007/s12022-015-9393-4.
11. Suda K, Mizuguchi K, Hebisawa A, Wakabayashi T, Saito S. Pancreatic tissue in teratoma. Arch Pathol Lab Med. 1984 Oct;108(10):835-7.

Anahtar Kelimeler

Choriocarcinoma syndrome , Emergency department , Germ cell testicular tumors , Pancreatitis.

Germ Hücreli Testis Tümörü Nüksü: Koryokarsinom Sendromu ve Akut Pankreatit Tablosu ile Seyreden Olgu Sunumu

Öz

Özet
Giriş: Koryokarsinom sendromu (KS), pulmoner hemoraji, yaygın metastazlar ve belirgin şekilde yükselmiş beta-insan koryonik gonadotropin seviyeleri ile karakterize olup, tanı ve tedavide önemli zorluklar yaratır.
Olgu Sunumu: Bu olgu sunumunda, acil servise koryokarsinom sendromuna (KS) bağlı akut solunum sıkıntısı sendromu (ARDS) ve pankreatit ile başvuran, nüks etmiş karışık germ hücreli testis tümörü olan nadir bir vaka sunulmaktadır.
Sonuç: KS, genellikle ileri evre germ hücreli tümörlerin bir komplikasyonu olarak ortaya çıkan nadir ancak oldukça ölümcül bir sendromdur. Bu hastalar genellikle acil servislere başvurduğundan, testis tümörü öyküsü olan genç erkek hastaların akut solunum sıkıntısı, hemoptizi, karın ağrısı veya pankreatit benzeri semptomlarla başvurmaları durumunda acil hekimlerinin KS’yi ayırıcı tanılar arasında düşünmesi kritik öneme sahiptir.

Anahtar Kelimeler

Koryokarsinom sendromu , Acil servis , Germ hücreli testis tümörleri , Pankreatit.

Kaynakça

• 1. Nauman M, Leslie SW. Nonseminomatous Testicular Tumors. 2023 Aug 14. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 33760513.
• 2. Xiao QF, Li J, Tang B, Zhu YQ. Testicular mixed germ cell tumor: A case report. World J Clin Cases. 2023 Oct 6;11(28):6902-6907. doi: 10.12998/wjcc.v11.i28.6902.
• 3. Rejlekova K, Cursano MC, De Giorgi U, Mego M. Severe Complications in Testicular Germ Cell Tumors: The Choriocarcinoma Syndrome. Front Endocrinol (Lausanne). 2019 Apr 12;10:218. doi: 10.3389/fendo.2019.00218.
• 4. Zeitjian VS, Arslan W, Borja-Alvarez A, Amar S. Choriocarcinoma Syndrome: A Potentially Fatal Complication of Testicular Cancer. Case Rep Oncol Med. 2019 Feb 24;2019:4092941. doi: 10.1155/2019/4092941.
• 5. Magudia K, Menias CO, Bhalla S, Katabathina VS, Craig JW, Hammer MM. Unusual Imaging Findings Associated with Germ Cell Tumors. Radiographics. 2019 Jul- Aug;39(4):1019-1035. doi: 10.1148/rg.2019180050.
• 6. Trpchevska EN, Todorovska B, Todorovska MB, Trajkovska M, Nikolova D, Dzambaz D, et al. Testicular Mixed Germ Cell Tumor Presenting with Upper Gastrointestinal Bleeding: A Case Report. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2023 Jul 15;44(2):47-52. doi: 10.2478/prilozi-2023-0024.
• 7. Tannous T, Miskovsky J, Keating M. Testicular Germ Cell Tumors: Paraneoplastic Syndromes and the Role of Beta-Human Chorionic Gonadotropin. Cureus. 2021 Apr 4;13(4):e14286. doi: 10.7759/cureus.14286.
• 8. Soputro NA, Roberts J, Wong S, Dias BH. Pretreatment of choriocarcinoma syndrome: a rare complication of metastatic germ cell tumours. BMJ Case Rep. 2022 Mar 2;15(3):e248172. doi: 10.1136/bcr-2021-248172. PMID: 35236696; PMCID: PMC8895934.
• 9. Kandori S, Kawai K, Fukuhara Y, Joraku A, Miyanaga N, Shimazui T, et al. A case of metastatic testicular cancer complicated by pulmonary hemorrhage due to choriocarcinoma syndrome. Int J Clin Oncol. 2010 Dec;15(6):611-4. doi: 10.1007/s10147-010-0092-3.
• 10. Agrawal T, Blau AJ, Chwals WJ, Tischler AS. A Unique Case of Mediastinal Teratoma with Mature Pancreatic Tissue, Nesidioblastosis, and Aberrant Islet Differentiation: a Case Report and Literature Review. EndocrPathol. 2016 Mar;27(1):21-4. doi: 10.1007/s12022-015-9393-4.
• 11. Suda K, Mizuguchi K, Hebisawa A, Wakabayashi T, Saito S. Pancreatic tissue in teratoma. Arch Pathol Lab Med. 1984 Oct;108(10):835-7.