[Metastasizing malignant germ cell tumor of the testis with infiltration of the thoracic aorta--a case for metastasis surgery].
METHODS
A 33-year-old man was admitted 7 years after a testicular teratomatous carcinoma had first been diagnosed, treated by a right orchiectomy and two-stage radical retroperitoneal lymphadenectomy. Five years later the first mediastinal metastases were treated with high-dosage chemotherapy and autologous germ-cell transplantation, and remaining paraaortic--mediastinal tumour tissue was resected. Two years later another tumour at that site was only partially resected. A curing treatment seemed impossible, because the aortic wall had been invaded.


METHODS
Five months after re-thoracotomy the metastasis and the invaded aortic segment were resected, the latter replaced by a vascular prosthesis. Histology indicated metastasis of a malignant teratoma of intermediate type. There has been no evident recurrence in the last 20 months.


CONCLUSIONS
Combined orchidectomy, lymphadenectomy, high-dosage chemotherapy with cisplatin and autologous germ-cell transplantation at present constitute the standard treatment of malignant testicular germ-cell tumour. In case of metastatic infiltration of vital structures, such as the aortic wall, special operative procedures can prolong the period of remission when the success of a standard treatment seems limited.
Baretti
R
R
Deutsches Herzzentrum Berlin. baretti@dhzb.de
Schaumann
B
B
Meyer
R
R
Alfaouri
D
D
Hetzer
R
R
D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D001807:Blood Vessel Prosthesis; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008479:Mediastinal Neoplasms / Q000556:secondary / Q000601:surgery; D009919:Orchiectomy; D012187:Retroperitoneal Space; D018243:Teratocarcinoma / Q000556:secondary* / Q000601:surgery*; D013736:Testicular Neoplasms / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D019043:Vascular Neoplasms / Q000556:secondary* / Q000601:surgery*