Upper Gastrointestinal Bleeding as Initial Presentation of Burned-out Testicular Tumor

Abstract

We report a case of 33-year-old man who initially presented with upper gastrointestinal bleeding caused by metastatic testicular can- cer. Physical examination was significant for a palpable abdominal mass. Emergency gastroduodenoscopy yielded an ulcerated in- filtrating mass in the third portion of the duodenum. Computerized tomography of the abdomen demonstrated a retroperitoneal mass. Histological examination of the retroperitoneal mass biopsy showed a nonseminamatous germ cell tumor consisting of embr- yonal cell carcinoma. Examination of the testes revealed a normal-sized firm left testis, and a normal right one. Ultrasonography of the testes showed multiple left testicular calcifications. The patient underwent left radical inguinal orchiectomy and histological exa- mination of the resected testis showed spontaneous regression of testicular germ cell tumor. We suppose that the tumor was a so- called 'burned-out' testicular tumor. He was treated with four courses of chemotherapy with cisplatin, etoposide and bleomycin. At five year follow-up, the patient was doing well, with no recurrens.