肝転移を来したトルコ鞍部Germ Cell Tumorに対するCisplatinとEtoposideの併用化学療法

Multiple Liver Metastases of a Suprasellar Germ Cell Tumor Treated with Combined Chemotherapy of Cisplatin and Etoposide

I．はじめに

　頭蓋内germ cell tumorの神経管外転移は現在までに数十例の報告があるが，血行性遠隔転移巣としては肺が最も多く^16），肝転移の報告は少ない．1913年Goldzie—her^3）の記載以来7例の報告があるが，いずれも予後は不良であり，進行期症例の治療は絶望的と言われる^2,46-8）．

　今回，われわれはトルコ鞍部に原発したgerm cell tu—morの肝転移例を経験した．本例に対し，cisplatinとetoposide（VP−16）による併用化学療法を行い完全寛解を得たので，文献的考察を加えて報告する．

Abstract

A 23-year-old man was admitted with progressively disturbed vision and easy fatigability. CT scans demon-strated an enhanced mass in the sellar region. Physical and endocrinological examinations revealed atrophy of both optic nerves, temporal field cuts in both eyes, and panhypopituitarism. Concentrations of human chorionic gonadotropin (HCG) in the serum and cerebrospinal fluid were 12 and 33IU/L, respectively. On November 11, 1987, the tumor was partially removed using the transsphenoidal approach. The histological diagnosis was germinoma with syncytiotrophoblastic giant cells.Following postoperative craniospinal irradiation (whole brain, 30Gy ; local, 18Gy ; spinal canal 28Gy), CT scans showed no residual tumor and the HCG levels decreased until they were undetectable.

Eighteen months later, the patient complained of abdominal pain. His serum HCG level had increased to 2,554 IU/L. CT scans of the abdomen revealed mul-tiple low density areas in the liver. Chest X-ray was negative. A Ga scintigram disclosed only liver metasta-sis. Administration of a chemotherapy was started on June 26, 1989. Cisplatin and etoposide in doses of 20mg and 40mg respectively were given for 5 consecutive days in one course. Following four courses of the com-bined chemotherapy, the tumor entirely disappeared on CT scans and the HCG level returned to normal. The patient is now able to work well without evidence of recurrence.

Multiple liver metastases of an intracranial germ cell tumor had been fatal in previous reports. This may be the first case with liver metastases in which the victim is still alive. The present case indicates that combined chemotherapy with cisplatin and etoposide is effective for extraneural metastases of an intracranial germ cell tumor.