Testicular cancer

[IdiotBoxen]

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I'm wondering something, have any of you seen a case of testicular choriocarcinoma?

And if so, what was the presentation and the workup done?

 

[Surfer75]

I've seen cases of teratomas, more routine seminomas, but no choriocarcinomas yet...

 

[IdiotBoxen]

Just wondering because of a case that came to my attention a week ago. Pt was 22. Feeling fine, very fit, no symptoms and had recently had physical before presentation. Initial presentation was for mild testicular pain after sport, however, the sharp family doctor thought something was up, sent for a testicular U/S. Mutli-agent chemo was attempted, but this didn't do anything to help. 4 weeks later pt was dead, with mets in brain, bone, lung... Path said it was a pure choriocarcinoma (which is exceedingly rare from my readings), although it took the director of pathology to figure out what it was...

Was just interested if other people had seen the same sort of thing... I really hate this sort of thing, can't do a damn thing. I hate it even more when a young pt dies so quickly 🙁

 

[kinetic]

Try not to think about it. There are lots of things in medicine that suck. What about people with hypertrophic obstructive cardiomyopathy? Let's hear it for sudden death in your 20s. How about MIs? Typical warning symptom? Death! Pancreatic cancer? (Relatively) SLOW death. HIV/AIDS? You're just sitting around twiddling your fingers waiting for your CD4 counts to fall and your viral load to jump and your first opportunistic infection to signal the beginning of the end. Say you're completely healthy and young; your most likely cause of death is an accident, right out of the blue. How about genetic diseases, like Huntington's? That's like being told when you're going to die and then having to count down the days until it happens. CF? We're getting better at it, but you're still most likely to make it to your 20s and it won't be a fun time making it there.

It sucks. I'm not trying to make light of the end of a human life. What I am trying to say is that, if you become overly burdened with it, you change nothing and only destroy your own mental sanity.

 

[drboris]

well said, kinetic

 

[IdiotBoxen]

I've had patients die before, but they were really old (one lady was 102 years old). They didn't affect me that much really.

I'll get over it. And I do understand about the need to remain sane 🙂

Now, has nobody but me seen a case of it??

 

[kinetic]

I've had patients die before, but they were really old (one lady was 102 years old). They didn't affect me that much really.

I'll get over it. And I do understand about the need to remain sane 🙂

Now, has nobody but me seen a case of it??

I personally don't look at patients' pee pees. That philosophy makes my life more bearable.

 

[Surfer75]

Actually, I had heard about a case of choriocarcinoma that progressed at the same speed you mentioned. It's pretty sad if missed or if there's ANY delay... because all in all, while awaiting confirmation or bx one should start chemo as soon as possible if chorio is at the top of the list because the cancer will spread like lightning as evidenced by the rapid doubling time of B-HCG. Chorios do have the worst prognosis in NSGCT. I don't think this is uncommon with cases like these, but still very unfortunate. Did the patient exhibit any signs of hyperthyroidism during the course? Just curious since there is crossreactivity between BHCG and TSH.

S

 

[IdiotBoxen]

By the time I became involved (I was working with anaesth doing pain mgmt, my selective (which was pretty bad to be honest)), it was impossible to differentiate between hyperthyroid appearing stuff, and the tumour and it's mets. But, yes, there were signs consistent with hyperthyroidism, like weight loss, anxiety, shaking hands, etc...

 

[Docxter]

I've done a lot of ultrasounds on scrotal masses, probably 40-50. Out of the ones that turned to be intratesticular masses (two-thirds were intrascrotal extratesticular), I've only seen one choriocarcinoma, which was metastatic.

The modes of presentation in these patients were quite variable: most commonly scrotal mass felt by patient, a few known lymphomas, one scrotal skin invasion (melanoma) with pus drainage, massive abdominal adenopathy causing GI and GU Sx, incidental adenopathy seen on CT taken for unrelated symptom, lung mets (cough), and brain mets (left sided weakness).