Vol. 45 (3): 629-633, May – June, 2019
CHALLENGING CLINICAL CASES
Syuan-Hao Syu 1, Chia-Lun Chang 2, Hung-Jen Shih 1, 3
1 Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan; 2 Department of Hematology, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan; 3 Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
Most patients with testicular germ cell tumor present with a painless scrotal mass. We report a 19-year-old patient who presented with neurological complains. Rapid clinical progression to coma was noted during the staging work up. A diagnosis of testicular mixed germ cell tumor with multiorgan metastasis (lymph node, lung, liver and brain) was made. Patients with brain metastasis should receive chemotherapy alone or combined with surgery or radiotherapy. Because the clinical symptoms deteriorated quickly, surgery was used upfront followed by chemotherapy and radiotherapy for the brain tumor. After the first stage of treatment, the clinical symptoms, tumor markers and imaging findings were improved. The residual brain tumor was eliminated by chemotherapy, and only sparse degenerated tumor cells were noted in the brain tissue.
Longer follow up is required to assess the impact of our treatment strategy.
Keywords: Testis; Testicular Germ Cell Tumor 1 [Supplementary Concept]; Neoplasm Metastasis