Cis-platin,Vinblastine,Bleomycinの三者併用化学療法後に脳転移をきたした非セミノーマ性睾丸腫瘍の1症例に対する治療経験

Abstract

A 23-year-old Japanese man was admitted with complaint of painless swelling of the right scrotal content. An egg-sized tumor was palpated in the left supraclavicular fossa and the chest X-ray disclosed multiple metastatic lesions. Bilateral gynecomastia was discovered. The right high orchiectomy was performed and the histological examination revealed seminoma with teratocarcinoma. Chemotherapy with CDDP, vinblastine and bleomycin was attempted. Pulmonary lesions and swelling of lymph node disappeared. Then the patient complained of visual disturbance. CT scan revealed a cerebral tumor, which was resected. Histological study disclosed pure embryonal carcinoma. This case shows that Einhorn's regimen is very effective upon the testicular cancer except cerebral metastasis. It may be due to the inability of drugs to cross the blood-brain barrier. Cerebral metastasis is not infrequent in the non-seminomatous testicular cancer. For example the records of Japanese pathological autopsy (1967-1976) showed that 15% of embryonal carcinoma and 36% of choriocarcinoma had cerebral metastasis. Therefore we must take care of cerebral metastasis in the management of non-seminomatous testicular cancer.