Easily missed diagnosis of testicular choriocarcinoma with a large retroperitoneal mass as the primary symptom: a case report

Abstract

Abstract Testicular choriocarcinoma is a relatively rare malignancy with a highly aggressive nature. Timely diagnosis and treatment can help prolong the survival of patients and even cure them. This case reports a 29-year-old male who presented to the clinic for a month with epigastric pain without complaints of discomfort in the reproductive system. On examination, only a massive mass of approximately 9*10 cm could be palpated in the upper abdomen. When asked about his previous history, the patient only described a history of a right inguinal hernia that had been repaired 12 years earlier without knowing that a testicular descending fixation had been performed at the same time (we only found out afterward by asking his parents). The admission diagnosis was considered the retroperitoneal tumor, which was found to have metastasized to the liver and lungs after the completion of relevant tests. We then performed a CT-guided puncture biopsy of the lung tissue. The biopsy pathology suggested only a tiny heterotypic cell mass, and metastatic cancer was considered. As the symptoms of tumor compression gradually worsened, we nevertheless performed surgical treatment (retroperitoneal tumor resection + partial duodenal resection + enteroanastomosis). The postoperative pathology was choriocarcinoma. It was at this point that we pursued the patient's medical history in detail and, at the same time, performed a testicular ultrasound which revealed a substantial occupation of the right testicle. The diagnosis of testicular choriocarcinoma was finally considered (without pathological confirmation). We wanted to start salvage chemotherapy as soon as possible after surgery. However, the patient's postoperative condition was poor, with rapid progression of hepatopulmonary metastases and gradually increased thyrotoxicosis, and we started salvage chemotherapy (EP regimen: etoposide and cisplatin) on postoperative day 12. However, the patient was forced to stop due to a severe chemotherapy reaction and eventually died of respiratory and cardiac arrest in hospital. For men presenting with a large retroperitoneal mass without reproductive system-related complaints, a detailed history of the inguinal testicle should still be inquired with a detailed physical examination. Meanwhile, laboratory and image tests should be performed to rule out the possibility of a genital tumor to avoid a missed diagnosis that could lead to delayed treatment.