UPPER GASTROINTESTINAL-BLEEDING AS INITIA L MANIFESTATION OF A NONSEMINOMATOUS TESTICULAR-CARCINOMA

History and clinical findings: For one week a 23-year-old man had been suffering from nausea and upper abdominal pain, followed by several b outs of haematemesis. On admission the haemoglobin level was 7.8 g/dl. Investigation: Endoscopy revealed a bleeding vessel stump at the post erior gastric wall: adrenaline was injected around it. A chest radiogr am showed numerous round foci in the lung, while physical examination found gynaecomastia and changes in the left testis suspicious of tumou r. beta-HCG (human chorionic gonadotrophin) activity was 230 000 U/l. Treatment and course: Histological examination of the immediately rese cted testis showed a necrotic non-seminomatous germ cell tumor (pT(1)N (2)M(1)). Repeat gastroscopy because of renewed tarry stools and haema temesis revealed bleeding from an area of polypoid mucosa. At laparoto my the lesion was excised. Histologically it was a submucosal metastas is of the testicular carcinoma. Chemotherapy resulted in normalisation of the beta-HCG-level. Subsequently retroperitoneal lymphadenectomy a nd bilateral theracotomy 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. Conclusion: Upper gastro intestinal bleeding from a haematogenous metastasis is a very rare ini tial manifestation of a testicular carcinoma. But a malignant tumour s hould be thought of in a young patient with unexplained haematemesis.