睪丸混合型生殖細胞瘤合併腦部轉移純粹絨毛膜癌及多處轉移:病例報告及文獻回顧
方楚文、蘇家震、沈坤宏、黃冠華
奇美醫學中心外科部泌尿外科
Mixed testicular germ cell tumor with pure brain metastatic choriocarcinoma and multiple metastasis: A case report and review of literature.
Chu-Wen Fang, Chia-Cheng Su, Kun-Hung Shen , Steven K. Huan
Department of Surgery, Division of Urology, Chi Mei Medical Center
Abstract
Testicular germ cell tumors are rare and representing about 1%-2% of all malignancies in males. The subtypes and frequency of germ cell tumors in the United States may include seminoma (40%), embryonal tumor (25%), teratocarcinoma (25%), teratoma (5%), and choriocarcinoma (pure; 1%).
Similar to other germ cell tumors, choriocarcinoma typically affects younger males and occurres most commonly in aged 20-30 years. It often metastasizes via hematogenous routes to the liver, lung, brain, and others.
Metastasis from testicular mixed germ cell tumor as pure choriocarcinoma is uncommon. In addition study showed that in case of hemorrhage from metastatic sites of choriocarcinoma, and with significant elevated level of serum beta-hCG, such condition is life-threatening conditions and required mandatory treatment.
The managements of choriocarcinoma include orchidectomy, chemotherapy, and retroperitoneal lymph node dissection. Study showed high-dose chemotherapy with autologous stem cell therapy were used in patients with partial responses to initial therapy. Moreover, collaborate team work approach for advanced nonseminomatous germ cell tumors is crucial.
Herein, we presented a case of 20-year-old man who was diagnosed mixed testicular germ cell tumor with pure brain metastatic choriocarcinoma and multiple metastasis, with the findings of metastatic site hemorrhage and elevation of serum beta-hCG.