[症例報告]縦隔原発非精上皮腫性胚細胞性腫瘍の1例

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A 16-year-old male patient was referred to our hospital because of left supraclaviclar lymphnode swelling and a mediastinal mass on chest X-ray film. The serum HCG, AFP and NSE values were extremely elevated. No abnormality was found in the testis. Chemotheapy with CDDP, VP-16 and BLM was begun immediately after supraclaviclar lymphnode biopsy indicated choriocarcinoma. After two courses of chemotherapy, the supraclaviclar and mediastinal mass were markedly decreased in size and the serum tumor markers normalized. Following chemotherapy, the residual tumors were extirpated and regional lymphnodes were dissected. The primary tumor consisted of necrotic tissue, and in the metastatic lesion, viable malignant cells were seen. Postoperatively, one course of the same chemotherapy as before surgery was added. Six months after discharge, lung metastasis with reelevation of serum HCG level was seen. The patient died 18 months after initial treatment. Mediastinal malignant germ cell tumor progresses so rapidly and its prognosis is so poor that aggressive multimodal therapy seems to be necessary.