Rapid Pulmonary Metastasis and Malignant Pleural Effusion during Follow-up in a Case of Stage I Non-Seminoma: A Case Report and Literature Review
Here, we report a case of stage I non-seminoma with vascular invasion that presented with rapid pulmonary metastasis and respiratory distress during follow-up. A 43-year-old male underwent high orchiectomy for a right testicular tumor at another hospital. Pathological examination revealed a mixed germ cell tumor with vascular invasion (non-seminoma, pT2N0M0S0; stage IB). The patient refused adjuvant chemotherapy and was scheduled for surveillance. Four months after surgery, CT at another hospital incidentally identified a right lung tumor. At that time, the AFP level was elevated to 1,384 ng/ml, and the lung tumor was diagnosed as metastasis from the testicular tumor. The patient also experienced respiratory distress and was urgently transferred to our hospital. Chest CT revealed an enlarged tumor in the right lung with a large pleural effusion, a significant mediastinal shift, and no visible normal lung tissue. Due to worsening respiratory distress, Bleomycin/Etoposide/Cisplatin (BEP) chemotherapy was immediately initiated. However, on the 6th day of treatment, the CT findings suggested drug-induced pneumonia. Therefore, Etoposide/Ifosfamide/Cisplatin (VIP) regimen was initiated as the 2nd cycle of chemotherapy. A gradual reduction in lung lesions was observed, and the patient eventually did not require oxygen therapy. Four cycles of VIP chemotherapy were administered with a combination of outpatient and inpatient care. Currently, AFP levels have normalized, and only minimal residual lung tumors remain. Subsequent surgical resection is planned.
