A 37-year-old man with the chief complaints of
lumbago and
fever is presented. Laboratory data showed the extreme elevation of alfa feto-
protein (AFP),
human chorionic gonadotropin (hCG) and
lactate dehydorgenase (LDH). Computed tomography (CT) scan revealed a huge retroperitoneal
tumor with
multiple pulmonary nodules as well as left supraclavicular and left axillary lymph nodes enlargement. Although he was suspected the
testicular tumor with
metastasis, he had no testicular abnormalities including
tumor and microlithiasis. Therefore, he was diagnosed as a retroperitoneal extra-gonadal
germ cell tumor, which had poor prognosis because of multiple
metastasis and the tremendous increase of hCG. Although he was treated with three cycles of
bleomycin,
etoposide, and
cisplatin (BEP), he achieved partial response and no normalization of
tumor markers. After three cycles of BEP, he was treated with four cycles of
paclitaxel and
ifosfamide plus
cisplatin (TIP) immediately. During
chemotherapy, he was treated with his
peripheral blood stem cell transplantation (PBSCT) as well. After the completion of two regimens'
chemotherapies, all his
tumor markers returned to be normal. However, retroperitoneal
tumor, left supraclavicular and axillary lymphnodes still remained. He underwent three operations including retroperitoneal lymphnode dissection with
nephrectomy, left supraclavicular and axillary lymphnodes removal, respectively. All specimens had no viable cells, histologically, The patient has been quite well and free of disease for 24 months. It is concluded that even if far-advanced
germ cell tumor is discovered, a more promising prognosis could be expected with intensive and aggressive treatment such as our case.