Testicular microlithiasis with mediastinal choriocarcinoma: a case report

A 19-year-old Japanese male developed a cough, chest pain, and high fever. CT of the chest revealed a bulky mediastinal tumor (13 x 10 x 8 cm) and bilateral multiple pulmonary nodules. CT of the abdomen and pelvis was normal. Laboratory evaluation showed a beta human chorionic gonadotropin (beta HCG) level of 985 ng/mL. Testicular ultrasonography demonstrated multiple, bilateral punctate echoes characteristic of testicular microlithiasis (TM). No primary testicular tumor was detected. Needle biopsies of the testes did not reveal cancer and calcification. Transthoracic needle biopsy of the mediastinal tumor showed choriocarcinoma. No correlation is known between TM and choriocarcinoma without testicular cancer, but the incidence of TM in this patient may reflect his high human chorionic gonadotropin level.