A 31-year-oldman presented with a 6-month history of right testicular enlargement. The patient underwent a right inguinal
orchiectomy. Histopathological examination showed
nonseminomatous germ cell tumor (
choriocarcinoma>
seminoma) which was confined to the tunica albuginea. The postoperative serum level of
alpha-fetoprotein (AFP) and
lactate dehydrogenase were normal. Serum level of human chorionic gonadotrophin(HCG), however, was 23,000 mIU/ml (normal, < 0.7 mIU/ml). A thoracic computed tomography (CT) at that time showed bilateral and multiple
metastases to the lungs but the abdominal CT was normal. After the surgery, the patient was treated with conventional doses of
cisplatin,
etoposide, and
bleomycin. On day 11 of the second
chemotherapy course, the patient developed
confusion and right sided weakness. Brain magnetic resonance imaging (MRI) showed an ischemic lesion in the left middle cerebral artery area. An echocardiogram showed normal left ventricular function and no valvular vegetations. Finally, the patient completed one additional course of
chemotherapy with considerable measures to prevent side effects. A thoracic CT at the end of the third cycle showed no evidence of
tumor. At 3 months followup after
chemotherapy, he suffered from partial
paralysis of right-sided upper and lower limbs but due to intensive rehabilitation he overcame the
paralysis and is able to walk by himself. There was no evidence of
tumor recurrence.