The therapeutic approach to intrathoracic metastases of non-seminomatous testicular tumour.

Before the era of chemotherapy an extensively metastasized non-seminomatous testicular tumour was nearly always fatal. Only 10 cases of spontaneous regression of thoracic metastasis have been reported. With chemotherapy, a much better outlook has been achieved, however, in 10% of the cases, chemotherapy resistant thoracic masses remain after treatment. In 70 to 80% of those cases with normal tumour markers, mature teratoma is found. In this paper, three patients with non-seminomatous testicular tumour and thoracic opacities resistant to conservative treatment are reported. One patient showed a complete disappearance of 9 out of 10 thoracic opacities 6 months after a short chemotherapy course, which had seemed to be ineffective. After a short period of reduction, the remaining opacity demonstrated continued tumour growth with a significantly longer tumour doubling time. The other two patients showed enlarged thoracic opacities despite combination chemotherapy and normal tumour marker levels. At the time of thoracotomy and complete surgical resection of the tumours all patients had normal tumour marker levels. Mature teratoma without genuine malignant cells was found microscopically. At this time all patients are free of metastases, 18, 3.5 and 2 year post thoracotomy. We suggest complete extirpation of the chemotherapy resistant lesions because, mature teratoma may give rise to compression and because in the cases with notwithstanding normalization of tumour markers and active tumour histology has to be obtained to restart combination chemotherapy.