[Metastasizing malignant germ cell tumor of the testis with infiltration of the thoracic aorta--a case for metastasis surgery].

HISTORY AND FINDINGS: A 33-year-old man was admitted 7 years after a testicular teratomatous carcinoma had first been diagnosed, treated by a right orchiectomy and two-stage radical retroperitoneal lymphadenectomy. Five years later the first mediastinal metastases were treated with high-dosage chemotherapy and autologous germ-cell transplantation, and remaining paraaortic--mediastinal tumour tissue was resected. Two years later another tumour at that site was only partially resected. A curing treatment seemed impossible, because the aortic wall had been invaded.

TREATMENT AND COURSE: Five months after re-thoracotomy the metastasis and the invaded aortic segment were resected, the latter replaced by a vascular prosthesis. Histology indicated metastasis of a malignant teratoma of intermediate type. There has been no evident recurrence in the last 20 months.

CONCLUSION: Combined orchidectomy, lymphadenectomy, high-dosage chemotherapy with cisplatin and autologous germ-cell transplantation at present constitute the standard treatment of malignant testicular germ-cell tumour. In case of metastatic infiltration of vital structures, such as the aortic wall, special operative procedures can prolong the period of remission when the success of a standard treatment seems limited.