Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan.
Department of Hematology, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan.
Int Braz J Urol. 2019 May-Jun;45(3):629-633. doi: 10.1590/S1677-5538.IBJU.2018.0523.
Most patients with testicular germ cell tumor present with a painless scrotal mass. We report a 19-year-old patient who presented with neurological complains. Rapid clinical progression to coma was noted during the staging work up. A diagnosis of testicular mixed germ cell tumor with multiorgan metastasis (lymph node, lung, liver and brain) was made. Patients with brain metastasis should receive chemotherapy alone or combined with surgery or radiotherapy. Because the clinical symptoms deteriorated quickly, surgery was used upfront followed by chemotherapy and radiotherapy for the brain tumor. After the first stage of treatment, the clinical symptoms, tumor markers and imaging findings were improved. The residual brain tumor was eliminated by chemotherapy, and only sparse degenerated tumor cells were noted in the brain tissue. Longer follow up is required to assess the impact of our treatment strategy.
大多数睾丸生殖细胞肿瘤患者表现为无痛性阴囊肿块。我们报告了 1 例 19 岁患者，其表现为神经系统症状。在分期检查过程中注意到快速进展至昏迷。诊断为睾丸混合生殖细胞肿瘤伴多器官转移（淋巴结、肺、肝和脑）。脑转移患者应单独接受化疗或联合手术或放疗。由于临床症状迅速恶化，因此首先采用手术，然后对脑肿瘤进行化疗和放疗。在第一阶段治疗后，临床症状、肿瘤标志物和影像学发现均得到改善。残留的脑肿瘤通过化疗消除，脑组织中仅稀疏地残留退化的肿瘤细胞。需要进行更长时间的随访以评估我们治疗策略的影响。
