A case of metastatic testicular germ-cell tumor with rhabdomyosarcoma successfully treated with germ-cell tumor-oriented chemotherapy

We report a case of metastatic testicular germ-cell tumor (GCT) with malignant transformation (MT) successfully treated with a GCT-oriented chemotherapy followed by surgery. A 48-year-old man presented with a right testicular tumor with retroperitoneal lymph node metastases. Pathological examination revealed that the primary tumor was rhabdomyosarcoma with mature teratoma, and the rhabdomyosarcoma element expressed placental alkaline phosphatase (PLAP) which is a marker of primitive germ cells or GCTs. After 4 cycles of GCT-oriented chemotherapy (VIP: etoposide, ifosfamide, and cisplatin), radiological partial response of retroperitoneal metastases was achieved, and subsequent retroperitoneal lymph node dissection revealed no remaining tumor cells. Our report suggests that GCT-oriented chemotherapy may be effective in treatment of patients with metastatic GCT with MT, particularly tumors which express PLAP in the MT element, although this disease entity has traditionally been considered to be chemoresistant.