A 23-year-old man was admitted to the hospital with a 3-week history of hemoptysis and progressive dyspnea. A chest radiograph on hospital admission revealed airspace consolidation in the periphery of the upper portion of both lungs with multiple nodules of variable sizes in both lung fields (Fig 1
). A CT scan of the chest confirmed the presence of pulmonary nodules with ground-glass opacities in both lungs, which is consistent with the presence of pulmonary hemorrhage (Fig 2
). On physical examination, no gynecomastia was noted. The abdomen was soft with no abnormal findings. A genital examination revealed no evidence of any scrotal masses. The remainder of the physical examination was unremarkable except for diffuse crackles in both lung fields. Under the impression of suspected germ cell tumors, a biological tumor marker study was performed. The result of a urine pregnancy test was positive, and the levels of β-HCG were very high at 1,600,000 IU/L in the serum (normal, < 5 IU/L) and 3,464,000 IU/L in the urine. However, the serum α-fetoprotein level was within normal limits (ie, 3.8 ng/mL). A transbronchial lung biopsy in the right lower lobe showed intense hemorrhage and fibrinoid deposits in the alveoli with a dimorphic population of malignant cells with hyperchromatic nuclei and multinucleated syncytiotrophoblasts, which is consistent with choriocarcinoma (Fig 3
), although a weak positive result of a β-HCG immunohistochemical stain was found to be due to limited lesions (data not shown). Based on the findings, a diagnosis of choriocarcinoma was made. The patient was given chemotherapy, which consisted of actinomycin-D, methotrexate, and cyclophosphamide. Despite aggressive chemotherapy and management in the ICUs, the patient’s condition deteriorated rapidly, and he died of acute respiratory failure 8 days after hospital admission. A request for an autopsy was denied.