My husband relapsed with immature teratoma after 4 xBEP. His surgeon in Europe suggests HDC and then surgery (if it is possible) and dr E suggests only surgery - chemo will not help. I will really appreciate your suggestion. I feel desperate. I want to help him!
His medical report:
Disease Course:
The disease manifested initially as a hemorrhagic left supraclavicular lymph node, following minor trauma (11/2015). Final diagnosis was delayed (02/2016) as the supraclavicular mass had been regarded as a post-traumatic hematoma. Due to its atypical clinical course and compression of the jugular vein, surgery was performed which revealed a hemorrhagic lesion with soft tissue components. Pathology report showed non-seminomatous germ cell tumor-embryonic carcinoma. At the time of diagnosis aFP was 1000, LDH: 800 and hCG was normal.
During disease staging, ultrasound examination showed testicular microlithiasis and a tumor measuring approximately 2 cm, while abdominal computed tomography revealed an extensive left retroperitoneal (total dimensions: 15x8cm) necrotic lymph node mass abutting the ipsilateral psoas muscle and extending to the renal hilum, as well as a right retrocrural (total dimensions: 8x6cm) necrotic lymph node metastatic mass.
Orchectomy was performed (03/2016) and pathology showed non-seminomatous germ cell tumor-embryonic carcinoma.
Between 03/2016 and 06/2016 the patient underwent 4 cycles of BEP regime without serious complications. At the end of chemotherapy, follow-up computed tomography showed complete resolution of the left supraclavicular mass, mild size decrease of the left retroperitoneal mass and no differentiation of the right retrocrural mass.
Due to remaining retroperitoneal masses post-chemotherapy, a retroperitoneal lymph node dissection was decided which was performed on 08/2017, in an experienced center of reference. Almost total resection (with a remaining 0.9cm component in contact with the renal vein) of the left reptroperitoneal mass with nerve sparing technique was achieved. At the same time, intra-surgical biopsies of the right retrocrural mass were obtained. Pathology report of the resected left retroperitoneal mass as well as the biopsies of the right mass, showed only necrosis/fibrosis. Thus no further treatment was suggested and 4-month follow-up computed tomography was recommended.
During follow-up, there was gradual increase in size of the right retrocrural mass, without aFP and LDH increase. A PET-CT scan was suggested which showed mildly increased uptake.
Due to gradual increase in size, resection of the right retrocrural mass was decided which was performed on 09/2017 at the same medical center. The retrocrural mass was completely resected and post-surgical pleural effusions represented the main complication which was resolved following tube placement. Pathology report of the resected mass revealed only necrosis/fibrosis, without teratoma or tumor cells. Thus no further treatment was suggested and 4-month follow-up with computed tomography was recommended.
On 11/2017, about 1 ½ months following the resection of the retrocrural mass, the patient complained of mild abdominal pain, nausea and vomiting. Blood investigations at that time showed liver dysfunction with elevated SGOT, SGPT and GGT. The rest of blood analysis, including tumor markers, was unremarkable. An ultrasound examination of the abdomen showed an extensive intrahepatic/perihepatic mass. Computed tomography was ordered (CT 05-11-2017) which revealed a large intrahepatic mass (approximately 13cm on maximum diameter) with necrotic and soft tissue components, containing thick septa, as well as a right retrocrural/posterior mediastinal mass of the same constitution (approximately 7x13cm). An ultrasound-guided biopsy of the masses was ordered. Pathology of the tissue sample of the retrocrural mass showed immature teratoma.
His medical report:
Disease Course:
The disease manifested initially as a hemorrhagic left supraclavicular lymph node, following minor trauma (11/2015). Final diagnosis was delayed (02/2016) as the supraclavicular mass had been regarded as a post-traumatic hematoma. Due to its atypical clinical course and compression of the jugular vein, surgery was performed which revealed a hemorrhagic lesion with soft tissue components. Pathology report showed non-seminomatous germ cell tumor-embryonic carcinoma. At the time of diagnosis aFP was 1000, LDH: 800 and hCG was normal.
During disease staging, ultrasound examination showed testicular microlithiasis and a tumor measuring approximately 2 cm, while abdominal computed tomography revealed an extensive left retroperitoneal (total dimensions: 15x8cm) necrotic lymph node mass abutting the ipsilateral psoas muscle and extending to the renal hilum, as well as a right retrocrural (total dimensions: 8x6cm) necrotic lymph node metastatic mass.
Orchectomy was performed (03/2016) and pathology showed non-seminomatous germ cell tumor-embryonic carcinoma.
Between 03/2016 and 06/2016 the patient underwent 4 cycles of BEP regime without serious complications. At the end of chemotherapy, follow-up computed tomography showed complete resolution of the left supraclavicular mass, mild size decrease of the left retroperitoneal mass and no differentiation of the right retrocrural mass.
Due to remaining retroperitoneal masses post-chemotherapy, a retroperitoneal lymph node dissection was decided which was performed on 08/2017, in an experienced center of reference. Almost total resection (with a remaining 0.9cm component in contact with the renal vein) of the left reptroperitoneal mass with nerve sparing technique was achieved. At the same time, intra-surgical biopsies of the right retrocrural mass were obtained. Pathology report of the resected left retroperitoneal mass as well as the biopsies of the right mass, showed only necrosis/fibrosis. Thus no further treatment was suggested and 4-month follow-up computed tomography was recommended.
During follow-up, there was gradual increase in size of the right retrocrural mass, without aFP and LDH increase. A PET-CT scan was suggested which showed mildly increased uptake.
Due to gradual increase in size, resection of the right retrocrural mass was decided which was performed on 09/2017 at the same medical center. The retrocrural mass was completely resected and post-surgical pleural effusions represented the main complication which was resolved following tube placement. Pathology report of the resected mass revealed only necrosis/fibrosis, without teratoma or tumor cells. Thus no further treatment was suggested and 4-month follow-up with computed tomography was recommended.
On 11/2017, about 1 ½ months following the resection of the retrocrural mass, the patient complained of mild abdominal pain, nausea and vomiting. Blood investigations at that time showed liver dysfunction with elevated SGOT, SGPT and GGT. The rest of blood analysis, including tumor markers, was unremarkable. An ultrasound examination of the abdomen showed an extensive intrahepatic/perihepatic mass. Computed tomography was ordered (CT 05-11-2017) which revealed a large intrahepatic mass (approximately 13cm on maximum diameter) with necrotic and soft tissue components, containing thick septa, as well as a right retrocrural/posterior mediastinal mass of the same constitution (approximately 7x13cm). An ultrasound-guided biopsy of the masses was ordered. Pathology of the tissue sample of the retrocrural mass showed immature teratoma.
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