title: [A suspected case of extra-gonadal germ cell tumor complicated with choriocarcinoma syndrome].
abstract: Our patient was a 31-year-old man who presented with right flank pain. Computed tomography revealed multiple tumors in the liver and lungs, with marked elevation of serum human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) levels. In addition, no testicular abnormalities were detected by palpation or ultrasonography. On the bases of these results, the patient was diagnosed with extragonadal germ cell tumor and was therefore started on chemotherapy with bleomycin, etoposide, and cisplatin (BEP). However, the result of a subsequent blood test showed marked pancytopenia at the initial stage of treatment. We speculated that the cause of anemia was not only bone marrow suppression but also intratumoral hemorrhage, collectively termed choriocarcinoma syndrome. After conservative treatment involving blood transfusion and administration of granulocyte colony-stimulating factor, he recovered. After several chemotherapy sessions, the levels of all tumor markers returned to normal. Finally, the patient underwent hepatectomy for residual tumors ; but, the resected specimen showed no viable cancer cells. Currently, the patient is free from disease since the last chemotherapy session, administered 5 months ago.
authors.affiliation: The Department of Urology and Renal Transplantation, Yokohama City University Medical Center.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nakamura
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hanai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sanjyo
authors.forename: Kengo
authors.initials: K
authors.lastname: Yasuda
authors.forename: Daiji
authors.initials: D
authors.lastname: Takamoto
authors.forename: Ayako
authors.initials: A
authors.lastname: Gohbara
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Teranishi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yumura
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Miyoshi
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kondo
authors.forename: Kazumi
authors.initials: K
authors.lastname: Noguchi
mesh_terms: D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols; D001761:Bleomycin / Q000008:administration & dosage; D031954:Choriocarcinoma, Non-gestational / Q000175:diagnosis*; D006063:Chorionic Gonadotropin / Q000097:blood; D002945:Cisplatin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis* / Q000188:drug therapy; D013577:Syndrome; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin