title: Germ cell cancer presenting as gastrointestinal bleeding and developing brain metastases: case report and review of the literature.
abstract: This paper describes a rare case of germ cell cancer with duodenum, brain and lung metastases. The patient presented with melena and left testicle enlargement. Orchiectomy revealed mixed germ cell cancer, enteroscopy revealed duodenal choriocarcinoma, and chest x-ray and computed tomography (CT) showed bilateral lung metastases. The patient received and tolerated cisplatinum-based chemotherapy, and responded well. However, he developed seizures 3 months later. MRI showed brain metastases and he was treated with whole-brain radiation. One month later, he developed progressive dyspnea. Chest CT showed worsening lung metastases. He received second-line chemotherapy, but died due to multiorgan failure. Germ cell cancer with nonpulmonary metastases has poor prognosis and the management of these patients requires a multimodal approach. Head CT should be considered as routine screening for all germ cell cancer patients on initial diagnosis and brain MRI should be considered for high-risk patients (with an embryo- or choriocarcinoma histology, dramatically elevated β-human chorionic gonadotropin and lung involvement).
authors.affiliation: Department of Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA.
authors.forename: Shuang
authors.initials: S
authors.lastname: Fu
authors.forename: Boris
authors.initials: B
authors.lastname: Avezbakiyev
authors.forename: Wanqing
authors.initials: W
authors.lastname: Zhi
authors.forename: Sreenath
authors.initials: S
authors.lastname: Kodali
authors.forename: Kaleem
authors.initials: K
authors.lastname: Rizvon
authors.forename: Artur
authors.initials: A
authors.lastname: Alaverdian
authors.forename: Lester
authors.initials: L
authors.lastname: Freedman
authors.forename: Jose
authors.initials: J
authors.lastname: Mejia
authors.forename: Ghulamullah
authors.initials: G
authors.lastname: Shahzad
authors.forename: Vladimir
authors.initials: V
authors.lastname: Gotlieb
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary*; D004379:Duodenal Neoplasms / Q000473:pathology / Q000556:secondary; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000150:complications* / Q000473:pathology*; D011859:Radiography; D013736:Testicular Neoplasms / Q000150:complications* / Q000473:pathology*; D055815:Young Adult