title: [Case of far-advanced retroperitoneal extra-gonadal germ cell tumor responding to intensive treatment including multi-drug chemotherapy with peripheral blood stem cell transplantation and residual tumor removal].
abstract: A 37-year-old man with the chief complaints of lumbago and fever is presented. Laboratory data showed the extreme elevation of alfa feto-protein (AFP), human chorionic gonadotropin (hCG) and lactate dehydorgenase (LDH). Computed tomography (CT) scan revealed a huge retroperitoneal tumor with multiple pulmonary nodules as well as left supraclavicular and left axillary lymph nodes enlargement. Although he was suspected the testicular tumor with metastasis, he had no testicular abnormalities including tumor and microlithiasis. Therefore, he was diagnosed as a retroperitoneal extra-gonadal germ cell tumor, which had poor prognosis because of multiple metastasis and the tremendous increase of hCG. Although he was treated with three cycles of bleomycin, etoposide, and cisplatin (BEP), he achieved partial response and no normalization of tumor markers. After three cycles of BEP, he was treated with four cycles of paclitaxel and ifosfamide plus cisplatin (TIP) immediately. During chemotherapy, he was treated with his peripheral blood stem cell transplantation (PBSCT) as well. After the completion of two regimens' chemotherapies, all his tumor markers returned to be normal. However, retroperitoneal tumor, left supraclavicular and axillary lymphnodes still remained. He underwent three operations including retroperitoneal lymphnode dissection with nephrectomy, left supraclavicular and axillary lymphnodes removal, respectively. All specimens had no viable cells, histologically, The patient has been quite well and free of disease for 24 months. It is concluded that even if far-advanced germ cell tumor is discovered, a more promising prognosis could be expected with intensive and aggressive treatment such as our case.
authors.affiliation: The Department of Urology, Saitama Medical Center, Saitama Medical University.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Yamashita
authors.forename: Makoto
authors.initials: M
authors.lastname: Morozumi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Takagi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yoshinaga
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ishii
authors.forename: Takaharu
authors.initials: T
authors.lastname: Matsuda
authors.forename: Toshiya
authors.initials: T
authors.lastname: Terao
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamada
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008197:Lymph Node Excision; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage; D036102:Peripheral Blood Stem Cell Transplantation; D012186:Retroperitoneal Neoplasms / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D001761:Bleomycin; D005047:Etoposide; D017239:Paclitaxel; D002945:Cisplatin; D007069:Ifosfamide