Successful treatment with cisplatin-based chemotherapy and post-chemotherapy operation for mediastinal nonseminomatous germ cell tumor with pulmonary metastasis

Abstract

In October 1988, a 19-year-old man was admitted with complaint of chest pain. Chest X-ray film and CT scan of the chest revealed a large mediastinal mass and several bilateral pulmonary nodules. Serum hCG and alpha-fetoprotein levels were 5096.0 mIU/ml (normal < 2.0) and 2176.9 ng/ml (normal < 10), respectively. Percutaneous needle biopsy of the mediastinal tumor disclosed an immature teratoma. The patient had normal testes on physical examination. CT scans of the brain and abdomen, and radioisotope scanning of the bones showed no abnormality. He was diagnosed as having a primary mediastinal nonseminomatous germ cell tumor (mixed cellular type) with pulmonary metastasis. On October 31, induction chemotherapy was started with PVB regimen: cisplatin 20 mg/m2 administered intravenously (i.v.) on days 1 through 5 every three week (three courses), vinblastine 0.15 mg/kg i.v. on days 1 and 2 every three weeks (three courses), and bleomycin 30 mg administered by i.v. push (starting on day 7) weekly x 9. Following the chemotherapy, serum alpha-fetoprotein fell to the normal range. Serum hCG decreased rapidly but did not reach the normal range. On January 7, 1989, en bloc resection of the residual primary tumor was performed which involved partial pericardiectomy and wedge resection of the left upper lobe. Four residual pulmonary nodules were also removed. Histologically, the surgical specimen was composed of fibrous, necrotic tissue mainly and immature teratoma partially.(ABSTRACT TRUNCATED AT 250 WORDS)