We describe a 56-year old male smoker who presented with bilateral gynecomastia and a large shadow in the upper zone of the right lung. Lobectomy revealed a haemorrhagic tumour at the apex of the right upper lobe. Histology revealed pure choriocarcinoma. Further investigations revealed normal testes and a retroperitoneal mass. Apart from histology, the other poor prognostic factors in this patient were the extragonodal site, gynecomastia and age. Complete remission was achieved with an aggressive 5-day chemotherapy regime. Primary retroperitoneal choriocarcinoma is extremely rare and is predominantly seen in the age group between 20–30 years.
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