TESTICULAR NONSEMINOMA WITH HIGH SERUM HUMAN CHORIONIC-GONADOTROPIN -THE TROPHOBLASTIC TERATOMA SYNDROME

Review of 26 patients presenting with metastatic non-seminomatous germ cell tumours (NSGCT) associated with serum human chorionic gonadotrop hin (HCG) >100,000 IU/1 between 1980 and 1990 suggested that this synd rome merits discrete recognition within the spectrum of germ cell tumo urs. All had lung metastases and in 23 these were very bulky by Medica l Research Council (UK) criteria. Other features included gynaecomasti a, rapid growth, and multi-system involvement. Following chemotherapy, there was initially a risk of tumour flare (4 patients). The time cou rse of radiological tumour clearance was slow. The overall prognosis w as 50% probability of 2-year survival and prognosis was worse with del ayed presentation or presentation with brain metastases. It is therefo re important to recognise this syndrome early and to proceed immediate ly with intensive combination chemotherapy.