P1309 - A Rare Case of Pure Choriocarcinoma Metastasis to the Duodenum in a Male With Previous Mixed Germ Cell Tumor

Parvir Aujla, MD¹, Rohit Khanna, DO², Abdullah Aleem, MD³, John Lyons, MD^2
1University of Texas Health Science Center, Houston, TX; ²Scripps Clinic, La Jolla, CA; ³University of Texas Health Science Center, Houston, AZ

Introduction: Pure Choriocarcinoma (PCC), an aggressive subtype of germ cell tumors, rarely metastasizes to the gastrointestinal (GI) tract, and a paucity of case reports describe GI bleed as the presenting symptom. A patient with a history of mixed germ cell tumor in remission presented with new-onset melena. Endoscopy revealed a bleeding, ulcerated duodenal mass and liver biopsy confirmed a new diagnosis of metastatic PCC.

Case Description/Methods: A 52 year old male with a history of mixed-germ cell testicular cancer (1999) status post right sided orchiectomy with recurrence resulting in retroperitoneal lymph node dissection and autologous stem cell transplant (2003) in remission presented with new-onset black tarry stools and solid-food dysphagia. He denied nausea, vomiting, diarrhea, unintentional weight loss, fevers, night sweats, sick contacts. He reported increased NSAID intake for one week for a right hand injury. Colonoscopy 8-months prior revealed sessile serrated and tubular adenomatous polyps. Social history includes a 20-pack year history and previous alcohol use disorder. Oncology work-up two years prior to admission demonstrated negative CT abdomen and pelvis and an undetectable AFP.

Physical exam was significant for melena. Labs notable for β-HCG >31,000, LDH 553, Hbg 8.8, PLT 191, WBC 6.7, iron sat 7, and ferritin 101. AFP and CMP were unremarkable. CT chest, abdominal, and pelvis showed innumerable pulmonary metastatic lesion, a large mediastinal mass externally compressing the esophagus,and hepatic lesions. Endoscopy revealed an ulcerated lesion in the upper one-third of the esophagus with extrinsic compression, and a large non-obstructive ulcerated mass in the proximal duodenum with distal clotted blood distal duodenum (Figure 1). Biopsy was deferred due to active bleeding. CT guided liver biopsy was found to have a PCC. Patient was referred to oncology for staging and treatment.

Discussion: PCC commonly metastasizes to the brain, lungs, lymph nodes and bones, and presents as seizures, stroke-like symptoms, mass effect, and hemoptysis. GI tract metastasis is rare, accounting for less than 5% of all cases. In a recent literature review, only sixteen cases of PCC presented as a GI bleed. Proposed mechanisms of action include direct tumor infiltration from retroperitoneal lymph node involvement and hematogenous dissemination. New-onset melena is a rare presentation for PCC and should be considered in the differential.



Disclosures:


Parvir Aujla, MD¹, Rohit Khanna, DO², Abdullah Aleem, MD³, John Lyons, MD². P1309 - A Rare Case of Pure Choriocarcinoma Metastasis to the Duodenum in a Male With Previous Mixed Germ Cell Tumor, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.