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Metastasectomy as optimal treatment for late relapsing solitary brain metastasis from testicular germ cell tumor: a case report.

Iida K, Naiki T, Kawai N, Ando R, Etani T, Tozawa K, Kohri K - BMC Res Notes (2014)

Bottom Line: The pathological diagnosis was yolk sac tumor.The alpha-fetoprotein level remained normal at 2 months after operation.There was no recurrence 24 months post-operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, 467-8601 Nagoya, Japan. rx-nike@hotmail.co.jp.

ABSTRACT

Background: Management of late relapse of a testicular germ cell tumor is difficult because few cases have been reported and the tumors are intractable to chemotherapy. Here we present a case with a single brain metastasis from late relapse of a testicular germ cell tumor. This is the first report of a brain metastasis that was treated successfully only by surgery.

Case presentation: A 19-year-old Japanese man presented with breathing difficulties and left testis enlargement and he was diagnosed with a yolk sac tumor following a left orchiectomy. At the time of diagnosis, multiple lung metastases were apparent on computed tomography, and serum alpha-fetoprotein level was elevated to 10,245 ng/ml. The patient received three postoperative courses of bleomycin, etoposide and cisplatin and etoposide and cisplatin respectively and a complete response was obtained. Four years after surgery, the patient was admitted to the hospital due to a sudden seizure. High alpha-fetoprotein levels (539 ng/ml) were evident and magnetic resonance imaging suggested a 45-mm single brain tumor in the right parietal lobe, for which surgery was performed. The pathological diagnosis was yolk sac tumor. The alpha-fetoprotein level remained normal at 2 months after operation. There was no recurrence 24 months post-operation.

Conclusion: Chemoresistance and late neurotoxicity are concerns in treating brain metastasis with chemotherapy or cerebral radiotherapy. Surgery is believed to be the optimal treatment choice if the size of the brain metastasis is larger than 35-mm and the late relapse area is surgically accessible.

No MeSH data available.


Related in: MedlinePlus

Hematoxylin and eosin staining of brain metastasis. Above, low magnification image. Below, high magnifications of brain tumor. Hematoxylin and eosin staining and positive immune-staining for alpha-fetoprotein. The final pathological diagnosis was a yolk sac tumor.
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Fig2: Hematoxylin and eosin staining of brain metastasis. Above, low magnification image. Below, high magnifications of brain tumor. Hematoxylin and eosin staining and positive immune-staining for alpha-fetoprotein. The final pathological diagnosis was a yolk sac tumor.

Mentions: A 19-year-old Japanese man consulted a family physician due to breathing difficulties. The left testis was enlarged to 15 cm in diameter, and multiple lung shadows were observed on a chest X-ray. The patient was then referred to our institution due to suspected lung metastases of testicular cancer. Left orchiectomy was performed and he was diagnosed with a yolk sac tumor (YST). At the time of diagnosis, multiple lung metastases were apparent on computed tomography (CT). Postorchiectomy serum levels of tumor markers were examined, with an elevated alpha-fetoprotein (AFP) level of 10,245 ng/ml, but otherwise normal with lactate dehydrogenase (LDH) level of 151 U/l and human chorionic gonadotrophin (HCG) level of 0.4 IU/L. Elevated AFP level indicated that he fulfilled the criteria of poor prognosis according to the International Germ Cell Consensus Classification [3]. The patient received three postoperative courses of bleomycin, etoposide and cisplatin (BEP) and etoposide and cisplatin (EP) respectively and a complete response was obtained. There was no recurrence post-operatively during follow-ups at 3–6 months intervals, according to serum marker levels and CT imaging from the chest to pelvis. Four years after surgery, the patient was transferred to the emergency department due to a sudden seizure. High AFP levels (539 ng/ml) were evident, although other markers were normal. Magnetic resonance imaging (MRI) suggested a 45-mm single brain tumor in the right parietal lobe, and no other tumor was evident, including the contralateral testis (Figure 1). Surgery was performed on the single brain metastasis. The pathological diagnosis was YST (Figure 2). The AFP level remained normal at 2 months after surgery. The patient has not had neurological disability. Moreover, there was no recurrence 24 months after surgery.Figure 1


Metastasectomy as optimal treatment for late relapsing solitary brain metastasis from testicular germ cell tumor: a case report.

Iida K, Naiki T, Kawai N, Ando R, Etani T, Tozawa K, Kohri K - BMC Res Notes (2014)

Hematoxylin and eosin staining of brain metastasis. Above, low magnification image. Below, high magnifications of brain tumor. Hematoxylin and eosin staining and positive immune-staining for alpha-fetoprotein. The final pathological diagnosis was a yolk sac tumor.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4265396&req=5

Fig2: Hematoxylin and eosin staining of brain metastasis. Above, low magnification image. Below, high magnifications of brain tumor. Hematoxylin and eosin staining and positive immune-staining for alpha-fetoprotein. The final pathological diagnosis was a yolk sac tumor.
Mentions: A 19-year-old Japanese man consulted a family physician due to breathing difficulties. The left testis was enlarged to 15 cm in diameter, and multiple lung shadows were observed on a chest X-ray. The patient was then referred to our institution due to suspected lung metastases of testicular cancer. Left orchiectomy was performed and he was diagnosed with a yolk sac tumor (YST). At the time of diagnosis, multiple lung metastases were apparent on computed tomography (CT). Postorchiectomy serum levels of tumor markers were examined, with an elevated alpha-fetoprotein (AFP) level of 10,245 ng/ml, but otherwise normal with lactate dehydrogenase (LDH) level of 151 U/l and human chorionic gonadotrophin (HCG) level of 0.4 IU/L. Elevated AFP level indicated that he fulfilled the criteria of poor prognosis according to the International Germ Cell Consensus Classification [3]. The patient received three postoperative courses of bleomycin, etoposide and cisplatin (BEP) and etoposide and cisplatin (EP) respectively and a complete response was obtained. There was no recurrence post-operatively during follow-ups at 3–6 months intervals, according to serum marker levels and CT imaging from the chest to pelvis. Four years after surgery, the patient was transferred to the emergency department due to a sudden seizure. High AFP levels (539 ng/ml) were evident, although other markers were normal. Magnetic resonance imaging (MRI) suggested a 45-mm single brain tumor in the right parietal lobe, and no other tumor was evident, including the contralateral testis (Figure 1). Surgery was performed on the single brain metastasis. The pathological diagnosis was YST (Figure 2). The AFP level remained normal at 2 months after surgery. The patient has not had neurological disability. Moreover, there was no recurrence 24 months after surgery.Figure 1

Bottom Line: The pathological diagnosis was yolk sac tumor.The alpha-fetoprotein level remained normal at 2 months after operation.There was no recurrence 24 months post-operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, 467-8601 Nagoya, Japan. rx-nike@hotmail.co.jp.

ABSTRACT

Background: Management of late relapse of a testicular germ cell tumor is difficult because few cases have been reported and the tumors are intractable to chemotherapy. Here we present a case with a single brain metastasis from late relapse of a testicular germ cell tumor. This is the first report of a brain metastasis that was treated successfully only by surgery.

Case presentation: A 19-year-old Japanese man presented with breathing difficulties and left testis enlargement and he was diagnosed with a yolk sac tumor following a left orchiectomy. At the time of diagnosis, multiple lung metastases were apparent on computed tomography, and serum alpha-fetoprotein level was elevated to 10,245 ng/ml. The patient received three postoperative courses of bleomycin, etoposide and cisplatin and etoposide and cisplatin respectively and a complete response was obtained. Four years after surgery, the patient was admitted to the hospital due to a sudden seizure. High alpha-fetoprotein levels (539 ng/ml) were evident and magnetic resonance imaging suggested a 45-mm single brain tumor in the right parietal lobe, for which surgery was performed. The pathological diagnosis was yolk sac tumor. The alpha-fetoprotein level remained normal at 2 months after operation. There was no recurrence 24 months post-operation.

Conclusion: Chemoresistance and late neurotoxicity are concerns in treating brain metastasis with chemotherapy or cerebral radiotherapy. Surgery is believed to be the optimal treatment choice if the size of the brain metastasis is larger than 35-mm and the late relapse area is surgically accessible.

No MeSH data available.


Related in: MedlinePlus