A CASE OF FAR-ADVANCED RETROPERITONEAL EXTRA-GONADAL GERM CELL TUMOR RESPONDING TO INTENSIVE TREATMENT INCLUDING MULTI-DRUG CHEMOTHERAPY WITH PERIPHERAL BLOOD STEM CELL TRANSPLANTATION AND RESIDUAL TUMOR REMOVAL

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  • Yamashita Takahisa
    The Department of Urology, Saitama Medical Center, Saitama Medical University
  • Morozumi Makoto
    The Department of Urology, Saitama Medical Center, Saitama Medical University
  • Takagi Daisuke
    The Department of Urology, Saitama Medical Center, Saitama Medical University
  • Yoshinaga Atsushi
    The Department of Urology, Saitama Medical Center, Saitama Medical University
  • Ishii Nobuyuki
    The Department of Urology, Saitama Medical Center, Saitama Medical University
  • Matsuda Takaharu
    The Department of Urology, Saitama Medical Center, Saitama Medical University
  • Terao Toshiya
    The Department of Urology, Saitama Medical Center, Saitama Medical University
  • Yamada Takumi
    The Department of Urology, Saitama Medical Center, Saitama Medical University

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Other Title
  • 末梢血幹細胞移植併用化学療法と残存腫瘍全摘出による集学的治療にて完全寛解を得た後腹膜原発性腺外胚細胞腫瘍の1例
  • 症例報告 末梢血幹細胞移植併用化学療法と残存腫瘍全摘出による集学的治療にて完全寛解を得た後腹膜原発性腺外胚細胞腫瘍の1例
  • ショウレイ ホウコク マッショウケツ カンサイボウ イショク ヘイヨウ カガク リョウホウ ト ザンソン シュヨウ ゼン テキシュツ ニ ヨル シュウガクテキ チリョウ ニテ カンゼンカンカイ オ エタ コウフクマク ゲンパツセイセン ガイハイサイボウ シュヨウ ノ 1レイ

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Abstract

A 37-year-old man with the chief complaints of lumbago and fever is presented. Laboratory data showed the extreme elevation of alfa feto-protein (AFP), human chorionic gonadotropin (hCG) and lactate dehydorgenase (LDH). Computed tomography (CT) scan revealed a huge retroperitoneal tumor with multiple pulmonary nodules as well as left supraclavicular and left axillary lymph nodes enlargement. Although he was suspected the testicular tumor with metastasis, he had no testicular abnormalities including tumor and microlithiasis. Therefore, he was diagnosed as a retroperitoneal extra-gonadal germ cell tumor, which had poor prognosis because of multiple metastasis and the tremendous increase of hCG.<br> Although he was treated with three cycles of bleomycin, etoposide, and cisplatin (BEP), he achieved partial response and no normalization of tumor markers. After three cycles of BEP, he was treated with four cycles of paclitaxel and ifosfamide plus cisplatin (TIP) immediately. During chemotherapy, he was treated with his peripheral blood stem cell transplantation (PBSCT) as well. After the completion of two regimens' chemotherapies, all his tumor markers returned to be normal. However, retroperitoneal tumor, left supraclavicular and axillary lymphnodes still remained. He underwent three operations including retroperitoneal lymphnode dissection with nephrectomy, left supraclavicular and axillary lymphnodes removal, respectively. All specimens had no viable cells, histologically, The patient has been quite well and free of disease for 24 months.<br> It is concluded that even if far-advanced germ cell tumor is discovered, a more promising prognosis could be expected with intensive and aggressive treatment such as our case.<br>

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