呼吸困難を契機に発見され集学的治療により寛解した進行精巣癌の1例

A 30-year-old man was referred to our hospital for examination and treatment of dyspnea.Clinical examination revealed multiple lung tumor masses with marked elevation -HCG and -fetoprotein. CT showed not only multiple lung tumors but also retroperitoneal tumor mass. Apercutaneous needle biopsy of lung tumor was performed and pathological findings suggestedchoriocarcinoma. Although testicular swelling was not detected, ultrasonography revealed a righttesticular mass lesion. Therefore we diagnosed multiple lung metastases from right testicularcancer with retroperitoneal lymph node metastasis. The induction chemotherapy with bleomycin,etoposide, cisplatin（BEP） for 3 cycles was performed. Subsequently second line chemotherapywith paclitaxel, ifosfamide, nedaplatin（TIN）for 8 cycles followed. After the tumor markers werenormalized, resection of residual lung metastases by video-assisted thoracic surgery（VATS）andright high orchiectomy were performed. Histologically no viable cells were detected. One cyclechemotherapy with TIN was given after first surgery. Secondly, retroperitoneal lymph nodedissection was performed, and pathologically the small amount of viable cancer was detected in theresected specimen. Then post operative chemotherapy with TIN for 2 cycles were performed.The patient is alive without any recurrence 3 years after combined modality therapy.