title: Gastrointestinal presentation of germ cell malignancy.
abstract: OBJECTIVE
  To summarize monoinstitutional experience with gastrointestinal (GI) presentations of germ cell malignancy and to review recent medical literature on this issue.
  
  
  METHODS
  Retrospective review of 5 cases with advanced germ cell malignancy (testicular 2 and retroperitoneal 3) and involvement of the upper GI tract and a comparison with published observation.
  
  
  RESULTS
  In 4 patients the duodenum and in 1 patient the distal part of the esophagus were involved in germ cell malignancy. In 3 patients grade 3 or grade 4 anemia represented the principle initial symptom. Ulceration of the upper GI tract was in 1 case complicated by an aortoduodenal fistula with rupture of the aorta. This patient and 2 other cases needed emergency surgery due to GI hemorrhage before and/or during the initial phase of chemotherapy. Our observations compare well with the literature, showing the need of multimodality therapy of these complications.
  
  
  CONCLUSIONS
  In young males with a malignant tumor in the upper GI tract, the diagnosis of germ cell malignancy should be considered. Treatment of this condition requires a multimodality approach, not rarely including emergency surgery. Though these patients often belong to a poor-prognosis group, our results and the literature review show that long-term survival is possible using modern treatment principles. In particular, the risk of GI hemorrhage, during the initial phase of therapy, should not be overseen.
authors: Department of Oncology, The Norwegian Radiumhospital, Oslo, Norway.
authors: C
authors: C
authors: Nord
authors: S D
authors: SD
authors: Fosså
authors: K E
authors: KE
authors: Giercksky
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000740:Anemia / Q000209:etiology; D001416:Back Pain / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D005770:Gastrointestinal Neoplasms / Q000556:secondary*; D018237:Germinoma / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013736:Testicular Neoplasms / Q000150:complications / Q000175:diagnosis*