Successful resection of massively enlarged residual pulmonary metastases from a nonseminomatous germ cell testicular tumor.

A 25-year-old man was referred to our hospital in June 2000 for treatment of massive enlargement of residual pulmonary metastases from a nonseminomatous germ cell testicular tumor. He had undergone right orchiectomy followed by cisplatin-based combination chemotherapy 7 years ago. Chest radiography and computed tomography showed complete opacification of the left hemithorax with mediastinal shift to the right, and two smaller nodules in the right lung. After salvage chemotherapy, elevated serum alpha-fetoprotein concentrations decreased to the normal range. Considering this response, we successfully resected the metastases via median sternotomy. Postoperative pathologic examination disclosed metastatic germ cell tumors composed of mature teratoma. The patient recovered uneventfully and has been alive for 6 years since residual metastasectomy. When technically possible, resection of even massive pulmonary metastases after a favorable response to chemotherapy for a nonseminomatous germ cell tumor, can provide pathologic assessment of the response and offer patients a chance of long-term survival.