Weidmann B, Eisenbach T, Börger R, Niederle N
Medizinische Klinik 3, Klinikum Leverkusen.
Dtsch Med Wochenschr. 1996 Nov 15;121(46):1428-32. doi: 10.1055/s-2008-1043164.
For one week a 23-year-old man had been suffering from nausea and upper abdominal pain, followed by several bouts of haematemesis. On admission the haemoglobin level was 7.8 g/dl.
Endoscopy revealed a bleeding vessel stump at the posterior gastric wall: adrenaline was injected around it. A chest radiogram showed numerous round foci in the lung, while physical examination found gynaecomastia and changes in the left testis suspicious of tumour. beta-HCG (human chorionic gonadotrophin) activity was 230,000 U/l.
Histological examination of the immediately resected testis showed a necrotic non-seminomatous germ cell tumor (pT1N2M1). Repeat gastroscopy because of renewed tarry stools and haematemesis revealed bleeding from an area of polypoid mucosa. At laparotomy the lesion was excised. Histologically it was a submucosal metastasis of the testicular carcinoma. Chemotherapy resulted in normalisation of the beta-HCG-level. Subsequently retroperitoneal lymphadenectomy and bilateral thoracotomy with resection of residual tumour tissue were performed: no active tumour was found histologically. There has been no sign of tumour recurrence after 56 months.
Upper gastrointestinal bleeding from a haematogenous metastasis is a very rare initial manifestation of a testicular carcinoma. But a malignant tumour should be thought of in a young patient with unexplained haematemesis.
一名23岁男性持续一周感到恶心和上腹部疼痛，随后出现数次呕血。入院时血红蛋白水平为7.8g/dl。
内镜检查发现胃后壁有一处出血的血管残端，在其周围注射了肾上腺素。胸部X线片显示肺部有许多圆形病灶，体格检查发现有男子乳腺发育以及左侧睾丸有可疑肿瘤的变化。β-HCG（人绒毛膜促性腺激素）活性为230,000U/l。
对立即切除的睾丸进行组织学检查显示为坏死性非精原细胞瘤性生殖细胞肿瘤（pT1N2M1）。因再次出现柏油样便和呕血而再次进行胃镜检查，发现息肉样黏膜区域出血。剖腹手术时将病变切除。组织学检查显示为睾丸癌的黏膜下转移。化疗使β-HCG水平恢复正常。随后进行了腹膜后淋巴结清扫术和双侧开胸手术以切除残留肿瘤组织：组织学检查未发现活性肿瘤。56个月后未出现肿瘤复发迹象。
血行转移导致的上消化道出血是睾丸癌非常罕见的初始表现。但对于不明原因呕血的年轻患者应考虑到恶性肿瘤的可能。
