SHM Converge Scientific Abstract ePoster Gallery-Metastatic Choriocarcinoma in an Incarcerated Patient: A Diagnostic and Therapeutic Challenge

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This case report describes a 30-year-old man who presented to the emergency department one day after release from incarceration with a painful right testicular mass, abdominal pain radiating to the groin, chest pain, and shortness of breath. He had been diagnosed with a testicular mass six months earlier but did not receive timely definitive treatment while incarcerated.<br /><br />Workup showed a large right testicular mass on ultrasound, retroperitoneal lymphadenopathy on CT abdomen, and extensive pulmonary metastases on CT chest. His tumor marker, hCG, was markedly elevated and tracked over time. He underwent right radical orchiectomy, and pathology revealed extensively necrotic and hemorrhagic choriocarcinoma with lymphovascular invasion. He also required small bowel resection after metastatic disease caused intussusception. Despite adjuvant chemotherapy, his disease progressed on follow-up imaging, leading to high-dose chemotherapy and autologous stem cell transplant.<br /><br />The case highlights several important points about testicular germ cell tumors and incarceration. Testicular cancer is the most common solid malignancy in males ages 15 to 40 and is highly curable when diagnosed early. However, cancer incidence is lower during incarceration and higher after release, suggesting underdiagnosis and delayed diagnosis in incarcerated individuals. Mortality is also disproportionately higher when cancer is diagnosed during incarceration or soon after release.<br /><br />The authors emphasize that barriers such as limited access to care, poor continuity of care, and untreated mental health or substance use issues can delay diagnosis and worsen outcomes. They recommend targeted support for incarcerated and recently released patients, and note that new billing codes for social determinants of health may help identify and address these barriers.

Asset Subtitle

Aaron Z. Reyes

Meta Tag

Author List Aaron Z. Reyes

Category Clinical Vignettes

Concept Metastatic Testicular Choriocarcinoma

Concept Testicular Germ Cell Tumor

Concept Choriocarcinoma

Concept Beta-hCG

Concept Orchiectomy

Distinguished Non-Finalist

Presenter Organization UCSD Health

Presenting Author Aaron Z. Reyes

Track Adult

Keywords

testicular cancer

choriocarcinoma

incarceration

delayed diagnosis

hCG

pulmonary metastases

retroperitoneal lymphadenopathy

orchiectomy

intussusception

autologous stem cell transplant

Metastatic Testicular Choriocarcinoma

Testicular Germ Cell Tumor

Choriocarcinoma

Beta-hCG

Orchiectomy