上大静脈腫瘍塞栓から右心房内へ進展した晩期再発型進行精巣腫瘍の1例

Abstract

A 24-year-old man was referred to our hospital with a painless mass on the left side of his neck. Ultrasonographydetected right testicular tumor and computerized tomographyscanning revealed a left supraclavicular lymph node mass and bulky retroperitoneal lymph node mass. He initially underwent right high orchiectomy, combination chemotherapy and retroperitoneal lymph node dissection for advanced testicular non-seminomatous germ cell tumor. Six years later, late relapse was detected in the lung. After complete remission of the lung metastasis with chemotherapy, the serum alpha-fetoprotein began to increase because of superior vena caval thrombus extending into the right atrium. Emergencysurgical excision was performed successfullyusing extracorporeal circulation to prevent pulmonaryembolism and the resected specimen pathologicallyrevealed adenocarcinoma interpreted as teratoma malignant transformation. Adjuvant chemotherapyconsisting of paclitaxel, ifosfamide and nedaplatin were administered for subsequent slight elevation of serum F-human chorionic gonadotropin β, resulting in successful normalization again. Later, he suddenlydied of cerebral infarction without anyevidence of recurrence 138 months after his initial presentation. We report herein an extremelyuncommon case of advanced testicular germ cell tumor with development of superior vena caval thrombus extending into the right atrium.