Correct!
2. Metastatic choriocarcinoma
The patient’s overall presentation and imaging findings are concerning for metastatic disease, as he is afebrile with weight loss with multiple pulmonary nodules and lymphadenopathy in both the chest and abdomen. Tuberculosis is unlikely as he is afebrile and the imaging findings are atypical for this diagnosis. Lymphoma is certainly a consideration given the lymphadenopathy, but the multiple large pulmonary nodules would be unusual for this diagnosis. Given the CT halo sign, a hypervascular malignancy is favored; however, the patient’s kidneys appeared unremarkable. In a male patient, a metastatic germ cell malignancy could present with variably-sized pulmonary nodules and masses as well as lymph node enlargement, particularly retroperitoneal lymphadenopathy.
The patient’s beta-hCG was found to be markedly elevated at 130,000 and there was concern for a metastatic germ cell tumor. Eventually, one of the lung nodules was biopsied under CT guidance and pathology was consistent with metastatic choriocarcinoma.
Diagnosis: Metastatic choriocarcinoma with lymphadenopathy and hemorrhagic pulmonary metastases
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