一名25岁的男性出现在我们医院,左臂肿胀逐渐恶化两个月,间歇性左侧胸压,和一个无痛的右睾丸肿块.胸部CT,腹部,骨盆显示有一个巨大的纵隔肿块,肺多发结节,和几个大的右睾丸结节。患者接受了右肺结节的CT引导活检,然后是根治性右腹股沟睾丸切除术.睾丸活检显示混合生殖细胞肿瘤(GCT)由97%的精原细胞瘤和3%的畸胎瘤组成,而肺活检显示转移性绒毛膜癌。患者接受了四个周期的博莱霉素治疗,依托泊苷,和铂(BEP),并显示出良好的临床反应,他的腹膜后淋巴结只有残留病.他被转诊为腹膜后淋巴结清扫术(RPLND);然而,延迟了几个月,导致他的疾病复发。他接受了四个周期的紫杉醇,异环磷酰胺,和顺铂,显示中度反应。他后来接受了大剂量卡铂和依托泊苷的抢救化疗,并接受了骨髓移植,导致完全的临床反应和根除他的疾病。睾丸GCT有不同的亚型,每个都有不同的发病机制,治疗方式,和预后。在这份报告中,我们讨论了一个患者,他的睾丸中出现了由精原细胞瘤和畸胎瘤组成的混合GCT,已经转移到他的肺和纵隔绒毛膜癌。该报告阐明了与原发性肿瘤相比,睾丸GCT转移为病理上不同的癌症的潜力。这种现象有显著的临床后果,因为它可以大大改变患者的治疗和预后结果。
A 25-year-old male presented to our hospital with two months of progressively worsening left arm swelling, intermittent left-sided chest pressure, and a painless right testicular mass. CT of the chest, abdomen, and pelvis revealed a large mediastinal mass, multiple lung nodules, and several large right testicular nodules. The patient underwent a CT-guided biopsy of his right lung nodule, followed by a radical right inguinal orchiectomy. The testicular biopsy revealed a mixed germ cell tumor (GCT) consisting of 97% seminoma and 3% teratoma, while the lung biopsy revealed metastatic choriocarcinoma. The patient was treated with four cycles of bleomycin, etoposide, and platinum (BEP) and showed a great clinical response, with only residual disease in his retroperitoneal lymph nodes. He was referred for retroperitoneal lymph node dissection (RPLND); however, there was a delay of several months, which led to the recurrence of his disease. He received four cycles of paclitaxel, ifosfamide, and cisplatin and showed a moderate response. He later received salvage chemotherapy with high-dose carboplatin and etoposide and underwent bone-marrow transplant, leading to complete clinical response and eradication of his disease. There are different subtypes of testicular GCTs, each with distinct pathogenesis, treatment modality, and prognosis. In this report, we discuss the case of a patient who presented with a mixed GCT consisting of seminoma and teratoma in his testicle, which had metastasized as choriocarcinoma to his lung and mediastinum. This report elucidates the potential for testicular GCTs to metastasize as a pathologically different cancer compared to the primary tumor. This phenomenon has significant clinical ramifications, as it can considerably alter a patient\'s treatment and prognostic outcomes.