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| Abstract |
A 32-year-old man presented with a mediastinal non-seminomatous germ cell tumor showing fluorodeoxyglucose (FDG) accumulation (maximum standardized uptake value = 22.21) and extremely elevated blood α...-fetoprotein (AFP) level (9203.0 ng/ml). The patient underwent 4 cycles of neoadjuvant chemotherapy (cisplatin, bleomycin, and etoposide), which normalized the AFP level and reduced the tumor size, allowing complete resection without a support of extracorporeal circulation. Despite preoperative positron emission tomography revealing increased FDG uptake in the residual tumor (maximum standardized uptake value = 3.59), the pathologic evaluation revealed that no viable germ cell tumor cells remained. We believe FDG uptake should not be used as a criterion for surgical resection after neoadjuvant chemotherapy. It is appropriate to resect the residual tumor regardless of FDG uptake after induction chemotherapy if a tumor is resectable and the AFP level normalizes.
症例は32歳男性。縦隔原発の非セミノーマ性胚細胞性腫瘍の診断で、PET-CTでFDG異常集積(SUVmax 22.21)、血液検査でAFP の異常高値(9203 ng/ml)を認めた。術前化学療法(シスプラチン、ブレオマイシン、エトポシド)4 サイクル施行後にAFPの正常化と腫瘍の縮小を認め、体外循環を使用することなく完全切除可能であった。術前のPET-CTで残存腫瘍にFDG異常集積(SUVmax 3.59)を依然認めていたにも関わらず、術後の病理診断では生存している悪性細胞を認めなかった。術前化学療法後に外科的切除を行うかどうかの判断基準の一つに、FDG異常集積を用いるべきではない。導入化学療法後に、腫瘍が切除可能でAFPの値が正常化していれば、FDGの集積とは関係なく、残存病変を切除することが望ましいと考えられる。show more
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