化学療法後に肺梗塞を生じた,下大静脈塞栓を伴う精巣腫瘍の1例

Abstract

21歳男.右陰嚢内の違和感を主訴とし精巣腫瘍が疑われたが, 術前に施行した骨髄生検の結果, 急性骨髄性白血病(AML)と診断され紹介された.高位精巣摘除術を施行し, 病理結果はembryonal carcinomaであった.精巣腫瘍に対する追加治療は行わず経過観察となった.AMLは化学療法により寛解した.その後, 精巣腫瘍再発をきたし, 腎門部から大動静脈分岐部へおよぶ最大径2cmのリンパ節腫大を多数認め, 胸部単純写真および胸部CTで肺野に多発性の転移を認めた.化学療法(BEP)を開始したが肺梗塞をきたし, IVCフィルター留置後, 化学療法を続行し, 2コースからはEP療法を行い, 4コース完了した.その後完全寛解し経過観察となり腫瘍の再発は認めていない

A 21-year-old male presented with right scrotal discomfort. Right high orchiectomy revealed non-seminoma and he was diagnosed with stage I non-seminoma. Since acute myeloid leukemia (AML) was diagnosed incidentally, no adjuvant therapy was given and he received chemotherapy for AML. One year later, he complained of lumbago and general malaise. Complete remission of AML had been achieved and bone marrow puncture revealed no signs of recurrence. Computed tomography showed retroperitoneal lymph node swelling, inferior vena caval embolus distal to the hepatic vein, and multiple lung nodules. Metastasis of testicular neoplasm was suspected and chemotherapy with Bleomycin, Etoposide, and Cisplatin was started. On the fourth day of chemotherapy, the patient complained of sudden dyspnea and acutely went into shock. Pulmonary embolism was diagnosed and an inferior vena cava filter was placed. Chemotherapy was continued for four courses and the tumor showed complete remission. He has been free of disease for 24 months. In rare cases of testicular cancer with inferior vena caval embolus, the physician should be aware of the possibility of causing pulmonary embolism after chemotherapy.