Case report of suspected primary pulmonary choriocarcinoma in a 43 year old male presenting for treatment of H. pylori

BACKGROUND: Choriocarcinoma is a rare cancer in males and is usually derived from the testicular intratubular germ cells. Extra-gonadal origins of the disease are possible but even more rare. Previous population analysis has shown the overall rate to be approximately 0.022 per 100,000. Among these, mediastinal-pulmonary origin is among the more common derivations and carries a poor prognosis. CASE INFORMATION: We present a case of a 43 year old male who presented to the gastrointestinal service for treatment of positive H. pylori from his primary care physician after a work up for abdominal pain, nausea and vomiting. A chest x-ray ordered for complaint of hemoptysis on intake history and physical revealed a large mediastinal mass and many disseminated opacities suspicious for metastatic disease. Further work-up revealed the lesion, originally thought to be squamous cell in origin, to be choriocarcinoma and a negative testicular ultrasound, despite a beta-hcg of over 10,000, led to a presumptive diagnosis of primary pulmonary choriocarcinoma (PCC). CONCLUSIONS: PCC is not entirely well studied due to its rarity and our case serves to illuminate an unusual presentation of a rare disease in a patient presenting to primary care with a very common complaint. Understanding of rare diseases and their warning symptoms serves to better prepare clinicians to catch rare and potentially lethal conditions that might otherwise be missed and lead to devastating consequences for patients.