肺転移による呼吸困難を契機に発見された巨大精巣腫瘍の1例

Abstract

19歳.肺転移による呼吸困難を契機に発見され, 経過中に脳転移を示した重量1700gの巨大精巣腫瘍例で, 脳転移に対して50Gyの全脳照射と化学療法を行い, 場合に応じて外科的切除を加えるのが良いとする報告があるが本症例では, 脳腫瘍の出血の為に重篤な神経症状が出現したため緊急に外科的切除が必要となり, 放射線療法を行わず, 術後に化学療法を施行し長期生存を得ている.脳転移を有する症例の予後は一般的に不良であり, 今後本症例が再発した場合, 末梢血幹細胞移植併用超大量化学療法を行う予定である

A 19-year-old male presented with dyspnea. Clinical examination revealed the left infant-head-sized testicular tumor, multiple lung metastases and retroperitoneal bulky lymph node metastasis with marked elevation of serum lactic dehydrogenase (LDH) and alpha-fetoprotein. Left radical orchiectomy followed by the chemotherapy with etoposide and cisplatin (EP) for 4 cycles was performed. The tumor weighed 1, 700 g, and was pathologically diagnosed as mixed germ cell tumor consisting of embryonal carcinoma and yolk sac tumor. After the treatment, the tumor markers were normalized with partial response (PR) of lung metastases and complete response (CR) of retroperitoneal lymph node metastasis. Thereafter, biopsy of lung metastases through video-assisted thoracoscopic surgery (VATS) was performed, and pathologically no viable cells were detected. Five months after the treatment, he was seized with convulsion due to brain metastasis with hemorrhage. Therefore, a surgical resection of brain metastasis and 2nd line chemotherapy with etoposide, ifosfamide and cisplatin (VIP) chemotherapy for 3 cycles was performed. The patient has been free of recurrence for 21 months after the 2nd line chemotherapy.