P3470 - Choriocarcinoma Presenting as a Rare Massive GI Bleed

Seth Lipshutz, DO¹, Malini Mathur, MD, FACG², Bryan Stone, DO³, Julian Remouns, DO², Victoria Burris, DO^4
1Jefferson Health Northeast, Philadelphia, PA; ²Lankenau Medical Center, Philadelphia, PA; ³Lankenau Medical Center, Wynnewood, PA; ⁴MRHC, Philadelphia, PA

Introduction: Pure choriocarcinomas are the most aggressive germ cell tumors and metastasize early, with half of patients presenting with metastatic disease, most commonly to the lungs. Testicular germ cell tumors metastasize in a predictable fashion involving the retroperitoneal lymph nodes first, followed by lymphatic or hematogenous spread to distant organs like lungs, liver and brain. Gastrointestinal metastasis of choriocarcinoma is exceedingly rare, present in only 5% of patients. Metastasis to the small bowel is even more rare than to the stomach. We present an extremely rare case of testicular carcinoma metastasizing to the jejunum causing a massive GI bleed.

Case Description/Methods: A 31 y/o male with PMHx of asthma presented to the ER with complaints of melena, dizziness, syncope, and testicular swelling. Initial labs were most remarkable for a Hgb of 3.8 g/dL. CTA of the Chest/Abdomen/Pelvis revealed pulmonary nodules, enlarged retroperitoneal lymph nodes, and a 10 x 9.8 cm right testicular mass. Patient required over 16 units of packed red blood cell transfusions during admission due to ongoing melena. GI was consulted for massive GI bleed, and patient initially underwent esophagogastroduodenoscopy (EGD)/colonoscopy. He then underwent push enteroscopy which revealed a large hemorrhagic jejunal mass, which was the source of his GI bleed, with another metastatic lesion 3 cm distal. Biopsies from enteroscopy confirmed metastatic choriocarcinoma from the testicle. He then underwent orchiectomy. Tumor markers were positive for CKAE (1/3), b-HCG and GATA3. Tumor markers from orchiectomy that followed enteroscopy were remarkable for a beta-hCG of 68672 and LDH of 311.

Discussion: Choriocarcinoma is a unique and aggressive germ cell malignancy, and these patients require early aggressive treatment to improve their chance of survival. Testicular germ cell tumors are rare and account for less than 1% of malignancies in males. Although there are multiple subtypes of germ cell tumors, choriocarcinoma is the most aggressive and least common. Testicular choriocarcinoma only metastasizes to the GI tract 5% of the time, of which the stomach is the most common location. Our patient presented with melena, requiring push enteroscopy revealing a hemorrhagic jejunal mass. The jejunal mass is what had diagnosed the patient's metastatic choriocarcinoma. Very few testicular choriocarcinoma metastasizing to the jejunum cases have been identified in literature prior presentation of our case.



Disclosures:


Seth Lipshutz, DO¹, Malini Mathur, MD, FACG², Bryan Stone, DO³, Julian Remouns, DO², Victoria Burris, DO⁴. P3470 - Choriocarcinoma Presenting as a Rare Massive GI Bleed, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.