衰退之混合型生殖細胞瘤併廣泛轉移：病例報告
方琬云 石宏仁 王百孚
彰化基督教醫院 泌尿科
Regressed mixed type germ cell tumor with extensive metastasis: A case report
Wan-Yun Fang, Hung-Jen Shih, Pai-Fu Wang
Division of Urology, Department of Surgery, Changhua Christian Hospital
Introduction:
“Regression” or “Burned out” was a rare and special phenomenon of tumor, the mechanism were still unclear nowadays. We present a case of mixed type germ cell tumor, whose primary tumor was burned out but extensive metastasis were found at diagnosis.
Case presentation:
A 50 years old male, without known underlying disease, had suffered from epigastric dull pain, poor appetite with intermittent nausea, a and body weight loss of 10kg within 2 moths at the beginning. He was diagnostic with peptic ulcer and hyperthyroidism at first, but abdominal mass, neck mass, and multiple lung lesion were also found. After he came to our hospital, Computerized tomography (CT) revealed multiple lung metastasis, including metastatic lymphadenopathy at bilateral common iliac and external iliac chains, para-aortic region with encasement of aorta and visceral branches, and left hydroneprhosis due to external compression of ureter by the lymphadenopathy. CT guide biopsy of abdominal lymphadenopathy showed metastatic malignancy, a metastatic germ cell tumor from testis, choriocarcinoma was suspected. However, there was no palpable mass over bilateral testis. Scrotal sonography revealed a 7*5mm cystic lesion over left testis. Laboratory data showed hCG β-subunit 747.9 mIU/mL, lactate dehydrogenase 731 U/L, alpha-fetoprotein 591.08 ng/mL. Since germ cell tumor was highly suspected, left orchiectomy was performed. Now the patient was under regular chemotherapy with Etoposide, Methotrexate, and Dactinomycin(EMACO), under diagnosis of mixed type germ cell tumor, seminoma and choriocarcinoma with multiple lymph nodes and lung metastasis.
Response to treatment of lymph nodes metastasis was soon noted after chemotherapy. Although anemia and emesis were complaint, much improvement of lymphadenopathy was observed by 3-month-follow-up CT scan.
Conclusion:
Even with extensive metastasis, fair control of malignancy may be possible after orchiectomy and chemotherapy. However, more study would be prerequisite for this kind of patients.