Dramatic response of teratoma-associated non-germ-cell cancer with all-trans retinoic acid in a patient with nonseminomatous germ cell tumor

A patient with nonseminomatous germ cell cancer, treated with standard chem otherapy, subsequently developed a pathologically confirmed metastatic undi fferentiated adenocarcinoma (non-germ-cell elements) arising from residual teratoma. Disease was present in both lobes of the liver and was deemed unr esectable at the time of presentation. The patient was treated on a Nationa l Cancer Institute-sponsored institutional protocol with all-trans retinoic acid. After 60 days of oral therapy at a dose of 150 mg/m(2)/d (50 mg/m(2) three times daily), the patient was found to have complete radiologic reso lution of his hepatic metastases. He subsequently underwent surgery and his complete response was pathologically confirmed.