PMC3636960_01
Abdominal CT (a) and lung CT (b) at the patient's presentation. Abdominal CT shows a huge retroperitoneal lymph node metastasis surrounding the vena cava and aorta. Lung CT shows multiple lung metastases. Abdominal CT (c) and lung CT (d) after 1 course of BEP therapy. The retroperitoneal mass and lung metastases were progressive. Abdominal CT (e) and lung CT (f) after 2 courses of VIP therapy. The retroperitoneal mass and lung metastases were still progressive. Abdominal CT (g) and lung CT (h) 1 year after IFN-alpha. The retroperitoneal mass is still growing slowly; however, the progression of the lung metastases is stabilized. The arrowhead shows the retroperitoneal lymph node metastasis.
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F1
AFP level was slightly higher (548 ng/ml), but the hCG level had continued to normalize (9.4 mIU/ml). Abdominal CT showed a huge mass surrounding the aorta and inferior vena cava (11 x 6 x 16 cm; fig. 1a), which was determined to be metastatic spread to the retroperitoneal lymph nodes. The largest lesion was 2.0 cm in diameter (fig. 1b). Despite this excellent response, there was a rapid increase in the number of lung lesions (from 38 to 72) (fig. 1c, d; fig. 2). After salvage therapy, the tumor markers were markedly decreased (AFP 28.4 ng/ml and hCG <0.1 mIU/ml), but the retroperitoneal mass (fig. 1e) and lung metastases (fig. 1f) continued to grow, with lung lesions now numbering 105. IFN-alpha administration resulted in a marked decrease in the rate of progression of the retroperitoneal mass (tumor doubling time was about 2 months before IFN-alpha and about 12 months after IFN-alpha; fig. 1g), and the lung metastases stabilized, with no new lesions detected (fig. 1h).