Massive hemorrhage from spontaneous rupture of a retroperitoneal lymph node in patient with metastatic mixed germ cell tumor

Abstract

Spontaneous hemoperitoneum secondary to metastatic foci of testicular germ cell tumor is a rare finding and is usually precipitated by the beginning of chemotherapy treatments. This acute presentation is usually due to the rupture of hepatic or gastrointestinal metastasis. We present the case of a 16-year-old boy who was admitted to the emergency room with acute abdominal pain and unstable vital signs, 10 days after a left orchiectomy for a testicular mixed nonseminomatous tumor. An urgent laparotomy demonstrated a significant peritoneal effusion (3 L) secondary to a ruptured retroperitoneal lymph node. More than 90% of the mass was resected with 3 cm of adherent jejunum. Pathologic findings revealed the mass to be composed of more than 95% of choriocarcinoma. The patient recovered well from the surgery and received standard chemotherapy with good response and no residual disease. Two and a half years after diagnosis, the patient is still in remission.