Upper Gastrointestinal Bleeding as Initial Presentation of Burned-out Testicular Tumor

We report a case of 33-year-old man who initially presented with upper gastrointestinal bleeding caused by metastatic testicular cancer. Physical examination was significant for a palpable abdominal mass. Emergency gastroduodenoscopy yielded an ulcerated infiltrating mass in the third portion of the duodenum. Computerized tomography of the abdomen demonstrated a retroperitoneal mass. Histological examination of the retroperitoneal mass biopsy showed a nonseminamatous germ cell tumor consisting of embryonal cell carcinoma. Examination of the testes revealed a normal-sized firm left testis, and a normal right one. Ultrasonography of the testes showed multiple left testicular calcifications. The patient underwent left radical inguinal orchiectomy and histological examination of the resected testis showed spontaneous regression of testicular germ cell tumor. We suppose that the tumor was a socalled 'burned-out' testicular tumor. He was treated with four courses of chemotherapy with cisplatin, etoposide and bleomycin. At five year follow-up, the patient was doing well, with no recurrens.