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CASE REPORT
xtragonadal
Retroperitoneal
Successfully
Carcinoma
Treated with Chemotherapy
HlRASAKI, Toshikazu MORIWAKI, Takao TSUZUKI, Ken HlRAO and Ichinosuke HYODO
E
Shoji
Embryonal
Case Report
Abstract
c
A 27-year-old Japanese man visited our hospital for A 27-year-old Japanese man visited our hospital for furfurther evaluation of multiple shadows on his chest X- ther evaluation of abnormal findings of a chest roentgenoray. A 6 cm hard mass was palpable in the left lower ab- gram from a yearly physical checkup on February 22, 2002. dominal region. Histological examination revealed that He had been in good health and no specific family or medithe lung tumor resected by the video-assisted thoracoal history was identified. scopic surgery was an embryonal carcinoma (EC). He Multiple tumors were demonstrated on his chest X-ray, was diagnosed as retroperitoneal EC with multiple lung and a contrast-enhanced computed tomography (CT) scan metastases. He underwent chemotherapy with cisplatin, (Fig. 1). These imaging examinations suggested metastatic etoposide, and bleomycin, followed by 3 courses. A cura- lung tumors. A 6 cm hard mass was palpable in the left lower tive surgical operation revealed that there were no malig- abdominal region. An abdominal contrast-enhanced CT scan nant cells in the lung lesions and primary lesion. This (Fig. 2) and magnetic resonance imaging (MRI) revealed a patient responded well to chemotherapy and achieved space-occupying lesion in the retroperitoneum. Ultrasound complete
remission
by chemotherapy.
(Internal
Medicine
42:
K
ey
1122-1126,
2003)
words: germ cell tumor, retroperitoneum, BEP therapy, alpha-fetoprotein, postchemotherapy resection
Introduction Male germ cell tumors (GCTs) predominantly the testis, however, a small subset of 1 to extragonadal origin (1, 2). Primary embryonal (EC) of the retroperitoneum is a relatively rare review of the literature revealed only 9
arise from 5% is of carcinoma disorder. A cases of
retroperitoneal
(3-10).
EC
in Japan
in the
past
15
years
EC
is highly malignant, but it can be cured with chemotherapy even in advanced cases (ll, 12). Herein we report the case of a Japanese man diagnosed as having retroperitoneal EC with multiple lung metastases that responded well to systemic combination chemotherapy consisting of cisplatin, etoposide
and
bleomycin.
examination of the testis revealed no abnormal findings. No other tumors were found elsewhere. Laboratory findings showed a red blood cell count of 459x1OVjliI,a white blood cell count of 6,100/jul and a platelet count of 23.3xlO7jul. The hemoglobin concentration was 14.4 g/dl. The levels of hepatic and biliary enzymes such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), leucin amino peptidase (LAP), and y-glutamyltranspeptidase (y-GTP) were normal except for lactate dehydrogenase (LDH) of 596 IU/Z (normal, 150-425 IU//). On renal function tests, blood urea nitrogen (BUN) and creatinine levels were normal. Tests for C reactive protein (CRP) revealed 0.27 mg/dl. Results of serological studies for hepatitis B and C viruses were negative. The levels of tumor markers were as follows: carcinoembryonic antigen, 1.3 ng/ml (normal
