Testicular choriocarcinoma. An unusual presentation as occult gastrointestinal blood loss

Choriocarcinoma is the rarest testicular germ cell tumor, occurring in less than 1% of cases. Gastrointestinal bleeding is not uncommon in cases of testicular choriocarcinoma and reflects metastatic disease. Typically, the patient presents with marked upper or lower gastrointestinal tract bleeding. A young adult male with metastatic testicular choriocarcinoma presented as a near-syncopal episode, with a hematocrit of 22% and hemoccult-positive stool. Endoscopy revealed a solitary bleeding lesion along the greater curvature of the stomach. His presentation suggested chronic, rather than acute, gastrointestinal blood loss. This case may represent the first case of testicular choriocarcinoma in which chronic gastrointestinal blood loss was the presenting manifestation of metastatic disease.