[Upper gastrointestinal bleeding as the first manifestation of a nonseminomatous testicular carcinoma].
METHODS
For one week a 23-year-old man had been suffering from nausea and upper abdominal pain, followed by several bouts of haematemesis. On admission the haemoglobin level was 7.8 g/dl.


METHODS
Endoscopy revealed a bleeding vessel stump at the posterior gastric wall: adrenaline was injected around it. A chest radiogram showed numerous round foci in the lung, while physical examination found gynaecomastia and changes in the left testis suspicious of tumour. beta-HCG (human chorionic gonadotrophin) activity was 230,000 U/l.


METHODS
Histological examination of the immediately resected testis showed a necrotic non-seminomatous germ cell tumor (pT1N2M1). Repeat gastroscopy because of renewed tarry stools and haematemesis revealed bleeding from an area of polypoid mucosa. At laparotomy the lesion was excised. Histologically it was a submucosal metastasis of the testicular carcinoma. Chemotherapy resulted in normalisation of the beta-HCG-level. Subsequently retroperitoneal lymphadenectomy and bilateral thoracotomy with resection of residual tumour tissue were performed: no active tumour was found histologically. There has been no sign of tumour recurrence after 56 months.


CONCLUSIONS
Upper gastrointestinal bleeding from a haematogenous metastasis is a very rare initial manifestation of a testicular carcinoma. But a malignant tumour should be thought of in a young patient with unexplained haematemesis.
Weidmann
B
B
Medizinische Klinik 3, Klinikum Leverkusen.
Eisenbach
T
T
Börger
R
R
Niederle
N
N
D000328:Adult; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D018237:Germinoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000556:secondary / Q000628:therapy; D013736:Testicular Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy
Obere gastrointestinale Blutung als Erstmanifestation eines nicht-seminomatösen Hodenkarzinoms.