Metastatic Testicular Choriocarcinoma of the Stomach: An Unusual Cause of Massive Upper Gastrointestinal Hemorrhage

睪丸胚細胞瘤(Testicular germ cell tumor)爲一少見之腫瘤，卻是15至35歲年輕男性最常患之實質腫瘤。其胃腸道之轉移，可見於約27%的解剖病例。因少有症狀産生，故臨床偵測率只有3.6〜4%。絨毛膜癌是所有睪丸胚細胞瘤轉至胃腸道之主要細胞成分。出血則爲妊娠滋養層疾患(gestationa trophoblastic disease)及睪丸絨毛膜癌轉移常見之併發症；但由睪丸絨毛膜癌轉移至胃腸道而引起胃腸道大量出血之病例卻相當罕見。一43歲男性，有十二指腸潰痬出血之過去病史，因呼吸困難，大量胃腸道出血和左側睪丸腫瘤而入院診療，入院理學檢查可見左側睪丸腫大（9×7.5×5公分），男性女乳症，及右側肺野呼吸聲減低。胸部X光顯示右側大量肋膜積水和縱隔寬度增加。內視檢查則見十二指腸球部變形，另外在胃下體部，前壁發現一有淺表潰痬之黏膜下腫瘤正在出血。經內視鏡生檢及經陰囊睪丸生檢均顯示爲絨毛膜癌，其血清中絨毛膜親生殖腺素(chorionic gonadotropin)值和甲種胎兒蛋白值分別爲30,000和84 ng/ml。患者在接受全身性化學藥物治療（包括methotrexate, actinomycin-D, cyclophosphamide和leucovorin）三個療程後，內視鏡檢查顯示該黏膜下腫瘤已消失，患者在診斷絨毛膜癌11個月後，死於全身性轉移。我們認爲睪丸胚細胞腫瘤患者，尤其是原發腫瘤含有絨毛膜癌成分者，出現有大量胃腸道出血時，應考慮胃腸道轉移之可能性。

關鍵字

胃腸道出血；轉移性胃腫瘤；睪丸絨毛膜癌

並列摘要

A 43-year-old patient with past history of recurrent bleeding from chronic duodenal ulcer presented with dyspnea, massive gastrointestinal bleeding and a testicular mass. Endoscopy revealed deformed duodenal bulb and a bleeding, ulcerated submucosal tumor at the anterior wall of the lower body of the stomach. Trans-scrotal testicular and endoscopic biopsies both demonstrated choriocarcinoma. The upper gastrointestinal bleeding was controlled after conservative treatment and systemic combination chemotherapy containing methotrexate, actinomycin-D, cyclophosphamide and leucovorin was given. After three courses of chemotherapy, follow-up endoscopy showed subsidence of the metastatic lesion. The patient died of wide-spread metastatic disease 11 months later without further bleeding.

並列關鍵字

gastrointestinal bleeding ； metastatic gastric tumor ； testicular choriocarcinoma

國際替代計量

Metastatic Testicular Choriocarcinoma of the Stomach: An Unusual Cause of Massive Upper Gastrointestinal Hemorrhage

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