Nishida Tatsuya, Nishiyama Noritoshi, Inoue Kiyotoshi, Kawata Yasuhiro, Ichikawa Tsuyoshi, Tsukioka Takuma, Wakasa Tomoko, Wakasa Kenichi, Suehiro Shigefumi
Department of Thoracic Surgery, Osaka City University Hospital, Japan.
Osaka City Med J. 2006 Dec;52(2):87-92.
A 25-year-old man was referred to our hospital in June 2000 for treatment of massive enlargement of residual pulmonary metastases from a nonseminomatous germ cell testicular tumor. He had undergone right orchiectomy followed by cisplatin-based combination chemotherapy 7 years ago. Chest radiography and computed tomography showed complete opacification of the left hemithorax with mediastinal shift to the right, and two smaller nodules in the right lung. After salvage chemotherapy, elevated serum alpha-fetoprotein concentrations decreased to the normal range. Considering this response, we successfully resected the metastases via median sternotomy. Postoperative pathologic examination disclosed metastatic germ cell tumors composed of mature teratoma. The patient recovered uneventfully and has been alive for 6 years since residual metastasectomy. When technically possible, resection of even massive pulmonary metastases after a favorable response to chemotherapy for a nonseminomatous germ cell tumor, can provide pathologic assessment of the response and offer patients a chance of long-term survival.
2000年6月，一名25岁男性因非精原细胞性生殖细胞睾丸肿瘤残留肺转移灶大量增大而被转诊至我院。7年前，他接受了右侧睾丸切除术，随后进行了以顺铂为基础的联合化疗。胸部X线和计算机断层扫描显示左半胸完全致密，纵隔向右移位，右肺有两个较小的结节。挽救化疗后，升高的血清甲胎蛋白浓度降至正常范围。考虑到这一反应，我们通过正中胸骨切开术成功切除了转移灶。术后病理检查显示转移性生殖细胞肿瘤由成熟畸胎瘤组成。患者恢复顺利，自残留转移灶切除术后已存活6年。在技术可行的情况下，对于非精原细胞性生殖细胞肿瘤，在对化疗有良好反应后，即使是大量肺转移灶的切除，也能提供反应的病理评估，并为患者提供长期生存的机会。
