A progressive malignancy

January 16, 2019

Figure 1 Quiz of the Week

A 28-year-old male presents with a three-month history of a chronic cough and weight loss. Upon further discussion, he mentions a painless lump in his left testicle. A firm mass is felt in the left testis on examination. A chest X-ray reveals the pulmonary lesions seen here and a scrotal ultrasound confirms the presence of a heterogenous tumor. Blood tests demonstrate highly elevated beta-hCG, slightly elevated lactate dehydrogenase (LDH), and normal alpha-fetoprotein (AFP) levels.

Which testicular malignancy does this patient most likely have?

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Image credit: @christopherblewett.

Answer: Choriocarcinoma

This patient’s clinical presentation and imaging findings suggest a diagnosis of testicular cancer with lung metastasis. Serum tumor markers (AFP, beta-hCG, and LDH) can aid in the diagnosis, staging, treatment, and surveillance of patients with testicular germ cell tumors. Highly elevated beta-hCG (often greater than 1000 IU/L) and normal AFP levels are typically seen in patients with choriocarcinoma. Management for choriocarcinoma includes orchiectomy and chemotherapy.

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