Primary retroperitoneal choriocarcinoma with pulmonary metastases in an elderly man

We describe a 56-year old male smoker who presented with bilateral gynaecomastia and a large shadow in the upper zone of the right lung. Lobectomy revealed a haemorrhagic tumour at the apex of the right upper lobe. Histology revealed pure choriocarcinoma. Further investigations revealed normal testes and a retroperitoneal mass. Apart from histology, the other poor prognostic factors in this patient were the extragonadal site, gynaecomastia and age. Complete remission was achieved with an aggressive 5-day chemotherapy regime. Primary retroperitoneal choriocarcinoma is extremely rare and is predominantly seen in the age group between 20-30 years.