title: A case of metastatic testicular cancer complicated by pulmonary hemorrhage due to choriocarcinoma syndrome.
abstract: A 40-year-old man was referred to our hospital for treatment of metastatic testicular cancer. Computerized tomography revealed multiple lung, liver, and retroperitoneal lymph node metastases. In addition, magnetic resonance imaging revealed multiple brain metastases. Induction chemotherapy with bleomycin, etoposide, and cisplatin was started the day after a high orchiectomy. The pathological diagnosis of the surgical specimen was yolk sac carcinoma. The serum human chorionic gonadotropin (hCG) was markedly increased to 630,000 mIU/ml, which suggested the presence of a choriocarcinoma element at metastatic sites. The patient subsequently suffered respiratory failure due to pulmonary hemorrhage. Intensive supportive care prevented a fatal outcome. Physicians who treat advanced testicular tumors should be aware of the potential complication of acute pulmonary hemorrhage, called choriocarcinoma syndrome, in cases with a high hCG level, which indicates a rapidly progressive and high-volume choriocarcinoma.
authors.affiliation: Department of Urology, Institute of Clinical Medicine, University of Tsukuba Graduate School of Comprehensive Human Sciences, 1-1-1 Tennodai, Tsukuba, Ibaraki 305, Japan.
authors.forename: Shuya
authors.initials: S
authors.lastname: Kandori
authors.forename: Koji
authors.initials: K
authors.lastname: Kawai
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Fukuhara
authors.forename: Akira
authors.initials: A
authors.lastname: Joraku
authors.forename: Naoto
authors.initials: N
authors.lastname: Miyanaga
authors.forename: Toru
authors.initials: T
authors.lastname: Shimazui
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Akaza
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000188:drug therapy / Q000556:secondary*; D002822:Choriocarcinoma / Q000150:complications* / Q000188:drug therapy / Q000556:secondary; D002945:Cisplatin / Q000008:administration & dosage; D018240:Endodermal Sinus Tumor / Q000188:drug therapy / Q000473:pathology*; D005047:Etoposide / Q000008:administration & dosage; D006470:Hemorrhage / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary*; D008297:Male; D011379:Prognosis; D013577:Syndrome; D013736:Testicular Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology
chemical_list: D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin