Choriocarcinoma of the Testis

Background

This is non-seminomatous germ cell tumor arising within the testis. These tumors recapitulate the placenta and are associated with an aggressive clinical course. Unlike other testicular tumors, the most common symptom is related to metatasis rather than a testicular mass. Hemoptysis (coughing up blood) and back pain. Pure tumors are extremely uncommon with most tumors part of a mixed germ cell neoplasm. These tumors characteristically secrete hCG into the serum.

SYNONYMS Choriocarcinoma

INCIDENCE Pure tumors very rare
0.3% of testicular tumors
Focal choriocarcinoma can be found in up to 8% of testicular germ cell neoplasms

HISTOPATHOLOGICAL VARIANTS CHARACTERIZATION

VARIANTS

Trophoblastic tumors of the testis other than classic choriocarcinoma: "monophasic" choriocarcinoma and placental site trophoblastic tumor: a report of two cases.

Ulbright TM, Young RH, Scully RE.

Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis 46202-5280, U.S.A.

Am J Surg Pathol 1997 Mar;21(3):282-8 Abstract quote

We report two unusual forms of testicular trophoblastic tumor.

One was a mixed germ cell tumor in a 19-year-old man that had a predominant component of nodules of cytotrophoblast cells with only rare syncytiotrophoblast cells. These nodules of "monophasic" choriocarcinoma were diffusely positive for human chorionic gonadotropin (hCG), which stained the syncytiotrophoblast cells more intensely; stains for human placental lactogen (HPL) highlighted only the latter cells. The second tumor occurred in a 16-month-old boy. It consisted of a pure proliferation of intermediate trophoblast cells and was identical to the placental site trophoblastic tumor of the uterus. The tumor cells showed diffuse immunoreactivity for HPL and patchy staining for hCG. Despite the occurrence of vascular wall invasion, the patient was alive and well at 8 years follow-up with no treatment other than orchiectomy. These cases show that trophoblastic tumors other than classic choriocarcinoma occur rarely in the testis.

The differential diagnosis of the "monophasic" choriocarcinoma included seminoma and the solid variant of yolk sac tumor, but the tumor had larger, more irregular nuclei than those of seminoma and was not associated with distinctive yolk sac tumor patterns.

The placental site trophoblastic tumor may be confused with Leydig cell tumor or choriocarcinoma, but awareness of its occurrence in the testis and the immunohistochemical findings should permit its recognition.

PROGNOSIS AND TREATMENT CHARACTERIZATION

Prognostic Factors
In general, pure tumors have a worse prognosis than other testicular germ cell neoplasms
If there is a greater amount of choriocarcinoma admixed with the tumor, it has an adverse effect on survival

Metastasis Tumor tends to metastasize widely
Lungs 100%
Liver 86%
GI tract 71%
Adrenal gland, spleen, brain 56%

Atlas of Tumor Pathology-Tumors of the Testis, Adnexa, Spermatic Cord, and Scrotum. AFIP 1997.

Commonly Used Terms

Testis

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Last Updated 2/21/2002

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SYNONYMS	Choriocarcinoma
INCIDENCE	Pure tumors very rare 0.3% of testicular tumors Focal choriocarcinoma can be found in up to 8% of testicular germ cell neoplasms

PROGNOSIS AND TREATMENT	CHARACTERIZATION
Prognostic Factors	In general, pure tumors have a worse prognosis than other testicular germ cell neoplasms If there is a greater amount of choriocarcinoma admixed with the tumor, it has an adverse effect on survival
Metastasis	Tumor tends to metastasize widely Lungs 100% Liver 86% GI tract 71% Adrenal gland, spleen, brain 56%