Rising tumour marker during chemotherapy in a patient with an extra-gonadal germ cell tumour--prolonged survival after tumour excision.

A 28-year-old white male presented with a palpable abdominal mass and a grossly elevated beta human chorionic gonadotrophin. He refused investigations to establish the pathology and was treated with cisplatin combination chemotherapy. After an initial fall in his marker, it rose while he was on chemotherapy. The tumour was resected which confirmed the presence of a retroperitoneal germ cell tumour (extra-gonadal). He received further adjuvant chemotherapy and is subsequently clear of disease after being off treatment for more than 5 years. Total resection is not usually considered possible in patients with persistent positive markers after induction chemotherapy. This case shows that surgery should be considered as the results of salvage chemotherapy are poor in these patients.