Onkológia 3/2019
The choriocarcinoma syndrome in men with germ cell tumors
Despite the rarity incidence of germ cell tumors, they count 1% of all malignancies, they are representing the most common type of solid tumors in men in reproductive ages between the ages 20-40 years and at the same time, they are one of the most curative malignancy overall. More than 90% of patients are long-term survivals because of effectiveness of the cisplatin-based chemotherapy. On the other hand, there is a group of super-high-risk patients, who because of some characteristics of their malignancy, shortly after beginning of chemotherapy application can develop choriocarcinoma syndrome connected with acute respiratory failure with high mortality rate in early phase of induction treatment. Currently, there is no exact explanation of choriocarcinoma syndrome in patients with very high choriogonadotropin level, massive lung metastases. Probably basic mechanism is massive cell lysis as a result of chemotherapy and cytokine release afterwards aggravated with alveolar hemorrhage, massive intra-alveolar tumor-lysis, early necrosis of tumor cells and consecutive superinfection, which can be furthered with neutropenia after chemotherapy and can lead to acute respiratory failure and death. Because of rarity and complexity of the therapy of those patients, patients’ referral to tertiary centers and the administration of induction chemotherapy in an intensive care unit setting could further improve the treatment outcome.
Keywords: choriocarcinoma syndrome, germ cell tumor, choriogonadotropin, acute respiratory failure, lung metastases
