Choriocarcinoma : Clinical Features
Clinical Features of Testicular Choriocarcinoma (CC): The patients are usually in their 3rd or 4th decade of life and frequently present with distant metastases. In many cases, there is no palpable testicular mass and the primary focus may remain occult even after the diagnosis of metastatic CC. The clinical features depend upon the site of metastases and can include hemoptysis, abdominal mass, neurological symptoms, anemia, hypotension, and cutaneous nodules. Serum hCG is elevated to several thousand mIU/L (ref. range 0-3 mIU/L). The alpha subunit of hCG shares structural homology with TSH and LH. As a result, some patients with trophoblastic tumors and elevated hCG levels can develop hyperthyroidism and/or gynecomastia. Like gestational trophoblastic disease, testicular CC is prone to hemorrhage, both spontaneously and after initiation of chemotherapy. This complication can be fatal if it involves a critical location such as brain or lungs. This gross specimen photograph is from a mixed germ cell tumor of the testis. The tumor consisted of choriocarcinoma (about 80% of the tumor; visible as a dark red-brown hemorrhagic nodule) and seminoma (about 20%; seen as a crescent-shaped area of pink-tan tissue in the center of the image). Choriocarcinoma is present as one of the components in about 15% of mixed germ cell tumors.