CLINICAL OBSERVATIONS OF CHORIOCARCINOMA OF THE TESTIS

Abstract

The purpose of the present paper is to briefly document the diagnosis and treatment of choriocarcinoma of the testis in cases seen at the Yokosuka National Hospital, Cancer Institute Hospital and Yokohama City University Hospital.
1. A total of 149 cases of testicular tumor were seen at these medical institutions during the period from January, 1962 to December, 1972. Of these 149, 10 (6.7%) were of choriocarcinoma.
2. The histological diagnosis of the malignancy in this series of 10 cases was made in various ways. In only 4 of these 10, ordinary histological examination of primary lesion revealed choriocarcinoma. In another 2 cases, definite diagnostic evidence was obtained by examination of serial sections of primary tumor. In the remaining 4 cases, routine histology of primary tumor failed to provide conclusive evidence of malignancy and the diagnosis was established only by biopsy of lymphatic metastases in 2 of them and by autopsy in the other 2.
3. Urinary HCG was found to be well correlated with neoplastic activity.
4. Gynecomastia was seen in 4 of the 10 cases.
5. In all cases but one, the patients died of malignancy, the prognosis of choriocarcinoma of the testis being thus very poor. The time period from the first examination to patient's death in these 9 cases ranged from 19 days to 2 years, averaging 10.6 months.
6. All the patients who died had extensive pulmonary metastasis.
7. Autopsy was performed in 6 of the 9 cases. As for organ metastasis, pulmonary metastasis was present invariably in all cases, hepatic metastasis in 5 cases, and the brain, kidneys and pancreas were involved in 2 cases each. With regard to lymphatic metastasis, retroperitoneal lymph nodes were found affected in one case; retroperitoneal lymph nodes and supraclavicular lymph nodes were concurrently involved in 2 cases. In the latter 3 cases, metastasis occurred probably through lymphatic channels.
8. In the chemotherapy of choriocarcinoma of the testis, an intermittent multidrug regimen proved to be effective. Our recommended chemotherapeutic regimen for Japanese patients is as follows: actinomycin D, 0.5mg per day, methotrexate, 5mg per day, and cyclophosphamide, 250mg per day, given in 5-day courses. Initial 4 to 5 courses of treatment are given at 2 to 3-week intervals and then, after an interval of 2 to 3 months, the treatment is repeated in the same way over an entire period of 2 years unless significant side effects occur.
Under this therapeutic regimen, serum LDH and urinary HCG returned to normal in one case. Another patient with stage I choriocarcinoma of the testis has now survived 4 years following orchiectomy which was done after 2 years of this particular chemotherapy.
9. Irradiation, which heretofore is considered useless, proved to be fairly effective in the treatment of lymphatic metastasis; gratifying results were obtained in one case with metastasis to retroperitoneal lymph nodes and in 4 with metastatic lesions of supraclavicular lymph nodes.