背景:纯睾丸绒毛膜癌是一种罕见类型的非精原细胞生殖细胞肿瘤,预后极差,转移部位容易出血。在诊断的时候,70%的患者有转移灶。根据转移的部位,症状各不相同。胃肠道受累的病例不到5%,大部分在十二指肠.
方法:我们介绍了一名47岁男性睾丸绒毛膜癌累及空肠,肺,肝脏,肾脏出现急性腹痛,Melena,伴有副肿瘤症状的呼吸困难.病人增加了,前四天右下腹剧烈持续疼痛。此外,他抱怨恶心,呕吐,厌食症,以及过去10天黑便的病史.劳累时呼吸困难,咯血,干咳是他的症状,差不多一年了。病人的一般外观是苍白的,生病,在过去的几个月里,瘦了10公斤的体重减轻。计算机断层扫描(CT)扫描报告肝叶和左肾多发转移灶。小肠病变样本的病理学研究显示转移性绒毛膜癌。之后,患者已被转介给肿瘤科医生以开始化疗方案。最后,患者在首次入院40天后已经死亡。
结论:睾丸绒毛膜癌在年轻男性中是一种罕见但致命的恶性肿瘤。胃肠道转移很少涉及黑便和急性腹痛,阻塞,和质量。医师应将其视为急腹症和消化道出血原因的鉴别诊断。
BACKGROUND: Pure testicular choriocarcinoma is a rare type of non-seminomatous germ cell tumor extremely poor prognostic with the tendency to bleed at the metastatic site. At the time of the diagnosis, 70% of patients have metastatic lesions. Depending on the site of the metastasis, symptoms vary. Gastrointestinal involvement is seen in less than 5% of cases, mostly in the duodenum.
METHODS: We present a 47 years old male with testicular choriocarcinoma involving the jejunum, lung, liver, and kidney presenting with acute abdominal pain, melena, and dyspnea with some paraneoplastic symptoms. The patient had increased, severe and constant pain in the right lower quadrant for the previous four days. Additionally, he was complaining of nausea, vomiting, anorexia, and a history of melena for the last 10 days. Dyspnea on exertion, hemoptysis, and dry cough were the symptoms he was suffering from, for almost one year. The patient\'s general appearance was pale, ill, and thin with 10 kg of weight loss during the last some months. The computed tomography (CT) scan reported multiple metastatic lesions in both liver lobes and the left kidney. Pathologic study of the samples of small bowel lesions showed metastatic choriocarcinoma. Following the patient had been referred to an oncologist to start the chemotherapy regime. Finally, the patient has expired after 40 days of his first admission.
CONCLUSIONS: Testicular choriocarcinoma is a rare but fatal malignancy among young men. Gastrointestinal metastases are infrequent involvement represented by melena and acute abdominal pain, obstruction, and mass. Physicians should consider it as a differential diagnosis for acute abdomen and gastrointestinal bleeding causation.