title: Metastasizing testicular germ-cell tumor with infiltration of the right heart: indication for primary metastasectomy.
abstract: Cardiac intracavitary metastases are very uncommon. The case of a 42-year-old male patient with a testicular germ cell tumor extending into the superior caval vein, the left brachiocephalic vein, and the right heart, which manifested as a mild form of pulmonary embolization, is presented. Due to the perceived high risk of continuous embolization and the urgent need to begin systemic chemotherapy, a complete cardiac tumor resection was performed, utilizing a cardiopulmonary bypass, followed by a simultaneous orchiectomy. Histology revealed a 61-cm long vascular tumor as a metastasis of a yolk sac tumor originating from the left testis. There were no postoperative complications, and the patient is alive and without tumor recurrence 12 months after four cycles of systemic chemotherapy according to the PEB (cisplatin, etoposide, bleomycin) scheme. We conclude that in this special case aggressive surgical management following chemotherapy was very effective in controlling the disseminated testicular tumor.
authors.affiliation: Urology Clinic, Carl-Thiem Hospital, Cottbus, Berlin-Charité University Teaching Hospital, Cottbus, Germany. M.May@ctk.de
authors.forename: Matthias
authors.initials: M
authors.lastname: May
authors.forename: Yorck
authors.initials: Y
authors.lastname: Finkbeiner
authors.forename: Sven
authors.initials: S
authors.lastname: Gunia
authors.forename: Matthias
authors.initials: M
authors.lastname: Seehafer
authors.forename: Joachim
authors.initials: J
authors.lastname: Knörig
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001761:Bleomycin / Q000008:administration & dosage; D002315:Cardiopulmonary Bypass; D002945:Cisplatin / Q000008:administration & dosage; D018240:Endodermal Sinus Tumor / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D005047:Etoposide / Q000008:administration & dosage; D006325:Heart Atria / Q000473:pathology; D006338:Heart Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D008297:Male; D009919:Orchiectomy; D011655:Pulmonary Embolism / Q000209:etiology; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000473:pathology
chemical_list: D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin