Garbay Delphine, Durrieu Françoise, Bui Binh, Italiano Antoine
Department of Medical Oncology, Institut Bergonié, Bordeaux, France.
Onkologie. 2012;35(1-2):40-2. doi: 10.1159/000335881. Epub 2012 Jan 20.
Bone marrow is a very unusual site of metastasis for germ cell tumors.
We report the case of a 21-year-old male patient who was treated with chemotherapy and secondary surgery for a primary mediastinal non-seminomatous germ cell tumor (NSGCT). The patient achieved complete remission. However, 4 months after completion of therapy, he complained of rapidly worsening bone pain. No evidence for disease relapse was found in the computed tomography scan of thorax and abdomen, magnetic resonance imaging of the spine, or bone scan. A blood test revealed pancytopenia and elevated serum tumor markers. A bone marrow aspirate showed infiltration by tumor cells positive for AE1/AE3 and AFP confirming the diagnosis of isolated bone marrow metastatic relapse. Salvage chemotherapy was started and resulted in a rapid decrease of serum tumor markers. However, pancytopenia did not improve and the patient died of severe sepsis 3 weeks later.
We report here the first case of isolated bone marrow metastatic relapse of an NSGCT. 2 other cases of bone marrow metastasis in patients with NSGCT have been reported. In these 2 cases, as in our patient, the primary site was not testicular but mediastinal suggesting a non-fortuitous association.
骨髓是生殖细胞肿瘤非常罕见的转移部位。
我们报告一例21岁男性患者，其原发性纵隔非精原细胞瘤性生殖细胞肿瘤（NSGCT）接受了化疗及二期手术治疗。患者实现完全缓解。然而，治疗结束4个月后，他主诉骨痛迅速加重。胸部和腹部计算机断层扫描、脊柱磁共振成像或骨扫描均未发现疾病复发证据。血液检查显示全血细胞减少及血清肿瘤标志物升高。骨髓穿刺显示肿瘤细胞浸润，AE1/AE3和甲胎蛋白呈阳性，确诊为孤立性骨髓转移性复发。开始挽救性化疗，血清肿瘤标志物迅速下降。然而，全血细胞减少未改善，患者3周后死于严重脓毒症。
我们在此报告首例NSGCT孤立性骨髓转移性复发病例。文献还报道了另外2例NSGCT患者发生骨髓转移的病例。在这2例病例中，与我们的患者一样，原发部位不是睾丸而是纵隔，提示存在非偶然的关联。
