title: Testicular germ cell tumor with rhabdomyosarcoma successfully treated by disease-adapted chemotherapy including high-dose chemotherapy: case report and review of the literature.
abstract: Treatment and prognosis have not been well characterized in germ cell tumors (GCT) with a malignant nongerm cell component. Patients with a mediastinal tumor, neural or rhabdomyosarcomatous differentiation and distant metastases have the poorest prognosis. We report a rare case of mixed GCT composed of seminoma, teratoma and rhabdomyosarcoma with the rhabdomyosarcomatous component metastasized into the liver and bone marrow (BM) causing hypercalcemia. The patient was treated with differentiation-tailored chemotherapy (CHT) including a disease-adapted high-dose (HD) CHT regimen with purified autologous PBSCT (APBSCT) and pamidronate. To date, remission has lasted for 4 years. Tumor-adapted CHT including HD-CHT with APBSCT can induce long term remissions in high-risk patients with transformed GCT. A review of the literature is given.
authors.affiliation: Department of Hematology, Oncology and Transfusion Medicine, Klinikum Benjamin Franklin, Freie Universität, Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Korfel
authors.forename: L
authors.initials: L
authors.lastname: Fischer
authors.forename: H D
authors.initials: HD
authors.lastname: Foss
authors.forename: H C
authors.initials: HC
authors.lastname: Koch
authors.forename: E
authors.initials: E
authors.lastname: Thiel
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001853:Bone Marrow / Q000473:pathology; D016190:Carboplatin / Q000008:administration & dosage; D002454:Cell Differentiation; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004164:Diphosphonates / Q000627:therapeutic use; D015251:Epirubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000628:therapy; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy; D009919:Orchiectomy; D000077268:Pamidronate; D012074:Remission Induction; D012208:Rhabdomyosarcoma / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary / Q000601:surgery / Q000628:therapy; D012640:Seizures / Q000209:etiology; D018239:Seminoma / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy; D013125:Spinal Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000628:therapy; D013724:Teratoma / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy; D014182:Transplantation, Autologous
chemical_list: D004164:Diphosphonates; D015251:Epirubicin; D005047:Etoposide; D016190:Carboplatin; D000077268:Pamidronate; D002945:Cisplatin