除睾後9年目に再発した睾丸腫瘍 (non-seminomatous germ cell tumor)の1例

Abstract

A case of recurrence of stage I non-seminomatous germ cell tumor of the testis (NSGCT) 8 years and 10 months after orchiectomy is presented. Histology was the same for the primary lesion and metastatic left supraclavicular lymphnodes: mixed pattern of choriocarcinoma, embryonal carcinoma, seminoma and teratoma. The patient underwent resection of the metastatic left supraclavicu lar and retroperitoneal lymphnodes. After receiving chemotherapy and radiotherapy postoperatively, he has been in complete remission for 11 months. It is well known that NSGCT relapses earlier than seminoma, and that most of the recurrences of stage I NSGCT occur within 24 months after treatment. Recently some investigators stress the importance of close follow-up of stage I NSGCT with CT scan and tumor markers for a period of 2 years without adjuvant chemotherapy or radiotherapy. But analysis on recurrence patterns shows that the recurrent disease, probably regardless of the time of its onset, progresses rapidly and systematically, and that the prognosis of advanced testicular tumors is poor even with intensive therapy. It is our conclusion that the period of close follow up should be longer than generally accepted so that late recurrence can be detected at its onset.