The Annals of Thoracic Surgery, Vol 30, 224-229, Copyright © 1980 by The Society of Thoracic Surgeons
Aggressive surgical management of testicular carcinoma metastatic to lungs and mediastinum
I Mandelbaum, SD Williams and LH Einhorn
During the past six years, more than 200 patients were treated with
chemotherapy for disseminated testicular cancer with a 70% complete
remission rate. In 22 patients who were 17 to 46 years old, there was
persistent thoracic disease, which was treated surgically. Six required a
median sternotomy for bilateral pulmonary involvement or mediastinal
metastasis. In 8 patients, chemotherapy had altered the histological
appearance of the metastases from that of an undifferentiated primary tumor
to a mature cystic teratoma. Five patients had nodules in the lungs, which
were necrotic and fibrosed with no evidence of tumor. Nine showed embryonal
cell carcinoma metastases in the lungs. All who had cystic teratoma are
alive and free from disease. Three of the 5 with nodules and 1 of the 9
with metastases are currently free from disease. Agressive surgical
intervention is important in this unique group of patients in order to
determine the precise pathological category of the lesions, to remove
intrathoracic malignancy, and to assess the need for additional
chemotherapy. An operative mortality of zero and a low morbidity justify
this approach.
