Late relapse of testicular cancer 21 years after first complete remission: a case report

Abstract

症例は42歳, 男性。AFP値が高いことを指摘されて当院を紹介受診した。この患者は21年間に非セミノーマの右精巣腫瘍の治療歴があった。当院受診時のCTでは右腎静脈から大動脈分岐まで下大静脈を圧排するような形で5×5cmの腫瘍を認めた。当院入院後, シスプラチン・エトポシド・パクリタキセル・イフォスファミドの4剤を併用した化学療法を施行した。しかし, 腫瘍は縮小せずAFP値も上昇した。そのためリンパ節郭清術・右腎摘出術・十二指腸部分切除術・下大静脈切除術を施行した。術後AFP値は正常範囲内に低下して, 現在約48ヵ月経過しているが再発は認めていない。(著者抄録)

We report here a case of very late relapse of a nonseminomatous germ cell tumor 21 years after first complete remission. A 42-year-old man, with a clinical history of right testicular cancer, was referred to our hospital with elevated serum alpha-fetoprotein (AFP) level. CT scan demonstrated a 5 x 5 cm retroperitoneal lymph node swelling compressing the inferior vena cava (IVC) extending from the right renal vein down to the bifurcation of the aorta. The patient received a total of four courses of combination chemotherapy consisting of cisplatin, etoposide, paxlitaxel, and ifosfamide. However, the retroperitoneal lymph node metastasis did not respond to chemotherapy, and the serum AFP level increased. Extended bilateral retroperitoneal lymph node dissection with right nephrectomy, partial duodenectomy, and vena cavectomy were performed. The patient has been followed up with no evidence of disease for 48 months after the operation without any further therapy.