睾丸絨毛皮腫の化学療法および剖検所見(症例報告)

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A 23-year-old man first noted the swelling of right testis and left supraclavicular mass with abdominal tumor and eminent gynecomastia. The chest X-ray film revealed multiple large metastases to both lungs. The urinary chorionic gonadotropin titer was 1,000,000 I.U. with estrogen value of 272 mg/day. An orchiectomy was performed on March 20, 1973. The pathological diagnosis was chorioepithelioma and embryonal carcinoma. He received intensive treatment with endoxan, actinomycin D and methotrexate (per os). The HCG titer sharply declined and became almost nearly zero with estrogen value of extremely low but not within normal range. Substantial regression of pulmonary and lymphnodes metastases was evident during continuance of chemotherapy. However, 5 months after the orchiectomy, a fit of apoplexy and various complications by drugs compelled to discontinuance of the chemotherapy and several months later, he died of cancerous cachexia. Autopsy findings demonstrated that the element of chorioepithelioma was predominantly found in the sites of brain, lung, and liver; on the other hand, that of embryonal carcinoma was found mainly in the lymphnodes metastases such as left supraclavicular and retroperitoneal lymphnodes. The relationship between the element of tumor and metastatic routes and the effects of chemotherapy were discussed.
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