Metastatic testicular cancer presenting with liver and kidney dysfunction treated with modified BEP chemotherapy combined with continuous hemodiafiltration and rasburicase

Abstract

A 25-year-old man was admitted to our hospital complaining of right scrotal pain and upper abdominal pain. A computed tomographic scan indicated a right scrotal mass, a huge liver mass, and multiple lung masses, although there was no enlarged retroperitoneal lymph node swelling. Laboratory tests showed severe liver and kidney dysfunction and high levels of serum α-fetoprotein (11,997 ng/ml). Although needle biopsies of the testicular and liver masses were performed, the tissues were insufficient for a pathological diagnosis. As liver and kidney function worsened, we started chemotherapy with bleomycin, etoposide, and cisplatin (BEP chemotherapy), which was modified because of the liver and renal dysfunction. We also used continuous hemodiafiltration and rasburicase to prevent tumor lysis syndrome. After induction of chemotherapy, the liver and kidney dysfunction improved immediately and the high orchiectomy was performed on day 8 after chemotherapy. The pathological diagnosis was a yolk sac tumor. He underwent four courses of the BEP regimen and five courses of the TIN regimen (paclitaxel, ifosphamide, and nedaplatin), followed by the resection of liver metastases. There was no evidence of viable cells in the resected liver and no recurrence was evident at 1 year postoperatively.

Fig. 1

(a) Pulmonary CT showed multiple pulmonary metastases. Abdominal CT showed (b) multiple large liver metastases, (c) thrombosis in a portal vein, and (d) a right testicular tumor. CT, computed tomography.

Fig. 2

The clinical course after admission. ALT, alanine aminotransferase; AST, aspartate aminotransferase; BLM, bleomycin; CDDP, cisplatin; CDGP, nedaplatin; CHDF, continuous hemodiafiltration; Cr, creatinine; ETP, etoposide.

Fig. 3

Microscopic findings of the testicular tumor at (a) low power and (b) high power.