Bone marrow metastases in a patient with primary mediastinal non-seminomatous germ cell tumor - an unusual pattern of relapse.
BACKGROUND
Bone marrow is a very unusual site of metastasis for germ cell tumors.


METHODS
We report the case of a 21-year-old male patient who was treated with chemotherapy and secondary surgery for a primary mediastinal non-seminomatous germ cell tumor (NSGCT). The patient achieved complete remission. However, 4 months after completion of therapy, he complained of rapidly worsening bone pain. No evidence for disease relapse was found in the computed tomography scan of thorax and abdomen, magnetic resonance imaging of the spine, or bone scan. A blood test revealed pancytopenia and elevated serum tumor markers. A bone marrow aspirate showed infiltration by tumor cells positive for AE1/AE3 and AFP confirming the diagnosis of isolated bone marrow metastatic relapse. Salvage chemotherapy was started and resulted in a rapid decrease of serum tumor markers. However, pancytopenia did not improve and the patient died of severe sepsis 3 weeks later.


CONCLUSIONS
We report here the first case of isolated bone marrow metastatic relapse of an NSGCT. 2 other cases of bone marrow metastasis in patients with NSGCT have been reported. In these 2 cases, as in our patient, the primary site was not testicular but mediastinal suggesting a non-fortuitous association.
Department of Medical Oncology, Institut Bergonié, Bordeaux, France.
Delphine
D
Garbay
Françoise
F
Durrieu
Binh
B
Bui
Antoine
A
Italiano
D019046:Bone Marrow Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000628:therapy; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000628:therapy; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000628:therapy; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis* / Q000556:secondary* / Q000628:therapy; D012008:Recurrence; D013736:Testicular Neoplasms; D055815:Young Adult