Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Oncology Reports
Published in: Current Oncology Reports 2/2015

01-02-2015 | Genitourinary Cancers (E Jonasch, Section Editor)

Testicular Choriocarcinoma: a Rare Variant that Requires a Unique Treatment Approach

Authors: Matthew James Reilley, Lance C. Pagliaro

Published in: Current Oncology Reports | Issue 2/2015

Login to get access

Abstract

Testicular germ cell tumors represent the most common malignancy among young men. While 5-year overall survival and cure for this population is greater than 95 %, choriocarcinoma is an aggressive subtype of this disease with far worse prognosis—5-year survival for choriocarcinoma is less than 80 %. In order to be able to treat these patients appropriately, a provider must recognize characteristic features of choriocarcinoma including elevated human chorionic gonadotropin in a young man with testicular mass; the astute clinician should also know the signs and symptoms of choriocarcinoma syndrome, characterized by bleeding from metastatic sites, which represents a medical emergency and is associated with high morbidity and mortality. Treatment should be directed towards a goal of tumor marker normalization, and patients with refractory disease should be considered for advanced therapies and clinical trials. Choriocarcinoma is a unique and aggressive germ cell malignancy, and these patients require early aggressive treatment to improve their chance of survival.
Literature
1.
DeSantis CE et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin. 2014;64(4):252–71.CrossRefPubMed
2.•
Stang A et al. Survival after a diagnosis of testicular germ cell cancers in Germany and the United States, 2002–2006: a high resolution study by histology and age. Cancer Epidemiol. 2013;37(4):492–7. Comparison of 5-year survival in the US and Germany of patients testicular cancer by pathologic subtype.CrossRefPubMedCentralPubMed
3.
Li MC, Hertz R, Bergenstal DM. Therapy of choriocarcinoma and related trophoblastic tumors with folic acid and purine antagonists. N Engl J Med. 1958;259(2):66–74.CrossRefPubMed
4.
Hertz R, Li MC, Spencer DB. Effect of methotrexate therapy upon choriocarcinoma and chorioadenoma. Proc Soc Exp Biol Med. 1956;93(2):361–6.CrossRefPubMed
5.
Freireich EJ. Min Chiu Li: a perspective in cancer therapy. Clin Cancer Res. 2002;8(9):2764–5.PubMed
6.
7.
Eble JN, Sauter G, Epstein JI, Sesterhenn IA, World Health Organization Classification of Tumours. Pathology and genetics of tumours of the urinary system and male genital organs. Lyon: IARC Press; 2004.
8.
Chieffi P, Chieffi S. Molecular biomarkers as potential targets for therapeutic strategies in human testicular germ cell tumors: an overview. J Cell Physiol. 2013;228(8):1641–6.CrossRefPubMed
9.
Sesterhenn IA, Davis Jr CJ. Pathology of germ cell tumors of the testis. Cancer Control. 2004;11(6):374–87.PubMed
10.
11.•
Alvarado-Cabrero I, Hernandez-Toriz N, Paner GP. Clinicopathologic analysis of choriocarcinoma as a pure or predominant component of germ cell tumor of the testis. Am J Surg Pathol. 2014;38(1):111–8. Comprehensive review of pathological features of choriocarcinoma with clinical correlates.CrossRefPubMed
12.
Malassine A, Cronier L. Hormones and human trophoblast differentiation: a review. Endocrine. 2002;19(1):3–11.CrossRefPubMed
13.
Chung K, Allen R. The use of serial human chorionic gonadotropin levels to establish a viable or a nonviable pregnancy. Semin Reprod Med. 2008;26(5):383–90.CrossRefPubMed
14.
Cole LA. Immunoassay of human chorionic gonadotropin, its free subunits, and metabolites. Clin Chem. 1997;43(12):2233–43.PubMed
15.
Batzer FR. Hormonal evaluation of early pregnancy. Fertil Steril. 1980;34(1):1–13.PubMed
16.
Carstairs SD. Diagnosis of testicular cancer with a urine pregnancy test in an austere military medical environment. Am J Emerg Med. 2013;31(11):1615.CrossRefPubMed
17.
Berger P et al. Human chorionic gonadotropin (hCG) in the male reproductive tract. Mol Cell Endocrinol. 2007;260–262:190–6.CrossRefPubMed
18.•
Logothetis CJ. The choriocarcinoma syndrome. Cancer Bull. 1984;36:118–20. Original article that first describes the choriocarcinoma syndrome.
19.
Das S, et al. Sudden death as a complication of choriocarcinoma. J Forensic Sci 2014.
20.
Syed S, Westwood AJ. Clinical reasoning: a 25-year-old man with headaches and collapse. Neurology. 2013;80(20):e211–4.CrossRefPubMed
21.
Logothetis CJ et al. Cyclic chemotherapy with cyclophosphamide, doxorubicin, and cisplatin plus vinblastine and bleomycin in advanced germinal tumors. Results with 100 patients. Am J Med. 1986;81(2):219–28.CrossRefPubMed
22.
Fu S et al. Germ cell cancer presenting as gastrointestinal bleeding and developing brain metastases: case report and review of the literature. Future Oncol. 2012;8(11):1487–93.CrossRefPubMed
23.
Beck SD, Patel MI, Sheinfeld J. Tumor marker levels in post-chemotherapy cystic masses: clinical implications for patients with germ cell tumors. J Urol. 2004;171(1):168–71.CrossRefPubMed
24.•
Einhorn LH et al. High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors. N Engl J Med. 2007;357(4):340–8. Large retrospective review of high-risk germ cell tumor patients who received high-dose chemotherapy with autologous stem transplantation demonstrating a significant number of patients with advanced disease who achieved cure.CrossRefPubMed
25.
Lewin J et al. High-dose chemotherapy with autologous stem cell transplantation in relapsed or refractory germ cell tumours: outcomes and prognostic variables in a case series of 17 patients. Intern Med J. 2014;44(8):771–8.CrossRefPubMed
26.
Kobek M et al. A unique case of malignant neoplasm—choriocarcinoma in a 24-year-old man—difficulties in differential diagnostics of intracranial injuries in the aspect of medicolegal opinion. Arch Med Sadowej Kryminol. 2013;63(3):216–9.PubMed
27.
Soussain C et al. Brain metastasis of choriocarcinoma in males. Apropos of a case. Review of the literature. Bull Cancer. 1992;79(8):751–7.PubMed
28.•
Oechsle K, Bokemeyer C. Treatment of brain metastases from germ cell tumors. Hematol Oncol Clin North Am. 2011;25(3):605–13, ix. Review article summarizing evidence behind current recommendations for management of brain metastases from germ cell tumors.CrossRefPubMed
29.
Salvati M et al. Brain metastasis from non-seminomatous germ cell tumors of the testis: indications for aggressive treatment. Neurosurg Rev. 2006;29(2):130–7.CrossRefPubMed
30.
Tatokoro M et al. Successful management of life-threatening choriocarcinoma syndrome with rupture of pulmonary metastatic foci causing hemorrhagic shock. Int J Urol. 2008;15(3):263–4.CrossRefPubMed
31.
32.
Senkal HA, Yilmaz T, Sozeri AB. Metastatic choriocarcinoma: a rare presentation as a neck mass. Ear Nose Throat J. 2013;92(6):E42.PubMed
33.
Heda P, Cushing G. Testicular choriocarcinoma presenting as hyperthyroidism. Am J Med. 2013;126(11):e1–2.CrossRefPubMed
34.
McCracken EJ et al. Testicular choriocarcinoma: an unusual case of paraneoplastic thyrotoxicosis. QJM. 2012;105(7):675–7.CrossRefPubMed
35.
Kohler S, et al. Paraneoplastic hyperthyroidism. BMJ Case Rep 2011.
36.•
Oosting SF et al. Prevalence of paraneoplastic hyperthyroidism in patients with metastatic non-seminomatous germ-cell tumors. Ann Oncol. 2010;21(1):104–8. Retrospective review that finds a high prevalence of paraneoplastic hyperthyroidism in germ cell malignancies with high levels of hCG.CrossRefPubMed
37.
Yoshimura M, Hershman JM. Thyrotropic action of human chorionic gonadotropin. Thyroid. 1995;5(5):425–34.CrossRefPubMed
38.
Hershman JM. Human chorionic gonadotropin and the thyroid: hyperemesis gravidarum and trophoblastic tumors. Thyroid. 1999;9(7):653–7.CrossRefPubMed
39.
Kawai K et al. A case of metastatic testicular cancer complicated by tumour lysis syndrome and choriocarcinoma syndrome. Jpn J Clin Oncol. 2006;36(10):665–7.CrossRefPubMed
40.
Blanke CD, Hemmer MP, Witte RS. Acute tumor lysis syndrome with choriocarcinoma. South Med J. 2000;93(9):916–9.CrossRefPubMed
41.
Yokoi K et al. Male choriocarcinoma with metastasis to the jejunum: a case report and review of the literature. J Nippon Med Sch. 2008;75(2):116–21.CrossRefPubMed
42.
Vardaros M et al. A case of gastrointestinal bleeding due to duodenal metastasis from a testicular choriocarcinoma. J Gastrointest Cancer. 2013;44(2):234–7.CrossRefPubMed
43.
Demirel D, et al. Testicular choriocarcinoma metastatic to the stomach: cytological, histological and immunocyto-histochemical findings. Cytopathology 2013.
44.
45.
Dasanu CA et al. Mediastinal choriocarcinoma presenting with syncope. Conn Med. 2013;77(8):473–5.PubMed
46.
47.
Subbiah V et al. Next generation sequencing analysis of platinum refractory advanced germ cell tumor sensitive to Sunitinib (Sutent(R)) a VEGFR2/PDGFRbeta/c-kit/ FLT3/RET/CSF1R inhibitor in a phase II trial. J Hematol Oncol. 2014;7:52.CrossRefPubMedCentralPubMed
48.
Oechsle K et al. Preclinical and clinical activity of sunitinib in patients with cisplatin-refractory or multiply relapsed germ cell tumors: a Canadian Urologic Oncology Group/German Testicular Cancer Study Group cooperative study. Ann Oncol. 2011;22(12):2654–60.CrossRefPubMed
49.
Feldman DR et al. Phase II trial of sunitinib in patients with relapsed or refractory germ cell tumors. Invest New Drugs. 2010;28(4):523–8.CrossRefPubMed
50.
51.
Chow LQ, Eckhardt SG. Sunitinib: from rational design to clinical efficacy. J Clin Oncol. 2007;25(7):884–96.CrossRefPubMed
52.
Madani A et al. Expression of KIT and epidermal growth factor receptor in chemotherapy refractory non-seminomatous germ-cell tumors. Ann Oncol. 2003;14(6):873–80.CrossRefPubMed
53.
Einhorn LH et al. Phase II study of imatinib mesylate in chemotherapy refractory germ cell tumors expressing KIT. Am J Clin Oncol. 2006;29(1):12–3.CrossRefPubMed
54.
Kata D et al. Testicular cancer developed in a chronic myeloid leukemia patient with a continued complete cytogenetic and molecular response to imatinib. A case report and review of the literature. Leuk Res. 2010;34(9):e229–31.CrossRefPubMed
55.
56.
Lanoix D et al. Melatonin: the smart killer: the human trophoblast as a model. Mol Cell Endocrinol. 2012;348(1):1–11.CrossRefPubMed
57.
Shiu SY et al. Inhibition of malignant trophoblastic cell proliferation in vitro and in vivo by melatonin. Life Sci. 2000;67(17):2059–74.CrossRefPubMed
Metadata
Title
Testicular Choriocarcinoma: a Rare Variant that Requires a Unique Treatment Approach
Authors
Matthew James Reilley
Lance C. Pagliaro
Publication date
01-02-2015
Publisher
Springer US
Published in
Current Oncology Reports / Issue 2/2015
Print ISSN: 1523-3790
Electronic ISSN: 1534-6269
DOI
https://doi.org/10.1007/s11912-014-0430-0

Other articles of this Issue 2/2015

Current Oncology Reports 2/2015 Go to the issue

Palliative Medicine (A Jatoi, Section Editor)

Respecting the Spiritual Side of Advanced Cancer Care: a Systematic Review

Breast Cancer (B Overmoyer, Section Editor)

Assessing the Role of Platinum Agents in Aggressive Breast Cancers

Breast Cancer (B Overmoyer, Section Editor)

Unique Aspects of Caring for Young Breast Cancer Patients

Breast Cancer (B Overmoyer, Section Editor)

Immunotherapy for the Treatment of Breast Cancer

Breast Cancer (B Overmoyer, Section Editor)

Targeting the Androgen Receptor in Breast Cancer
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits