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HISTORY AND CLINICAL FINDINGS For one week a 23-year-old man had been suffering from nausea and upper abdominal pain, followed by several bouts of haematemesis. On admission the haemoglobin level was 7.8 g/dl. INVESTIGATION Endoscopy revealed a bleeding vessel stump at the posterior gastric wall: adrenaline was injected around it. A chest radiogram showed numerous round foci in the lung, while physical examination found gynaecomastia and changes in the left testis suspicious of tumour. beta-HCG (human chorionic gonadotrophin) activity was 230,000 U/l. TREATMENT AND COURSE Histological examination of the immediately resected testis showed a necrotic non-seminomatous germ cell tumor (pT1N2M1). Repeat gastroscopy because of renewed tarry stools and haematemesis revealed bleeding from an area of polypoid mucosa. At laparotomy the lesion was excised. Histologically it was a submucosal metastasis of the testicular carcinoma. Chemotherapy resulted in normalisation of the beta-HCG-level. Subsequently retroperitoneal lymphadenectomy and bilateral thoracotomy with resection of residual tumour tissue were performed: no active tumour was found histologically. There has been no sign of tumour recurrence after 56 months. CONCLUSION Upper gastrointestinal bleeding from a haematogenous metastasis is a very rare initial manifestation of a testicular carcinoma. But a malignant tumour should be thought of in a young patient with unexplained haematemesis.

Sister chromatid exchanges rates (SCE) were studied in peripheral blood lymphocytes of 10 patients with acute lymphoblastic leukaemia (ALL) or leukaemic transformed non-Hodgkin-lymphomas (NHL) and in lymphocytes of 10 healthy juvenile donors (control). Following treatment the patient group has been in continuous complete remission for 11 months on the average. In the number of SCE's significant differences were found: 10,90/metaphases in the patients versus 7,56/metaphases in the controls. These results significantly show a long time influence of the treatment on the SCE rates, possibly inducing chromosome aberrations.