A Complex Case of Testicular Choriocarcinoma in Cryptorchidism and Choriocarcinoma Syndrome: Clinical and Treatment Insights.

BACKGROUND Testicular choriocarcinoma is a rare, non-seminomatous germ cell tumor (NSGCTs) that accounts to less than 1% of all testicular malignancies. There are no clear criteria for its definitive management. Typically, cases of testicular choriocarcinoma have a grim prognosis, involving hematogenous spread to the lymph nodes, lungs, liver, bones and brain. CASE REPORT This report describes the case of a 52-year-old man with an untreated cryptorchidism who presented to a primary care clinic with a painless swelling in the right inguinal region, which was progressively increasing in size over 3 months. He was married and had 3 children. Physical examinations revealed a right inguinal swelling measuring 20 cm (length)×11 cm (width)×10 cm (depth), extending into the scrotum. Urgent referral to the urologist was made and investigations revealed markedly elevated beta human chorionic gonadotropin (bhCG) at 236 335 IU/L. The contrast-enhanced computed tomography (CECT) scans of the abdomen and pelvis confirmed testicular cancer with metastasis to the lymph nodes, liver, lungs and bones. The patient underwent 6 cycles of neoadjuvant chemotherapy, followed by orchidectomy and adjuvant chemotherapy. Histopathological results confirmed testicular choriocarcinoma with the presence of lymphovascular invasion, which indicates a poor prognosis. Despite initial response to treatment, he experienced seizures 2 months postoperatively, and subsequent computed tomography (CT) scans indicated brain metastasis. Unfortunately, 10 months after diagnosis he died due to the disease resulting from choriocarcinoma syndrome. CONCLUSIONS Testicular choriocarcinoma poses a significant clinical challenge due to its rarity and aggressiveness. Individualized and multidisciplinary management approaches are essential for effectively addressing this challenging condition.