Cervical mature teratoma 17 years after initial treatment of testicular teratocarcinoma: report of a late relapse

A 20- year- old patient underwent left sided orchiectomy followed by systemic therapy and retroperitoneal residual mass resection in 1989. He remained in complete remission for 200 months. In 2005 a huge left supraclavicular neck mass with extension to anterior mediastinum appeared. Radical surgical resection of the mass was performed and pathologic examination revealed mature teratoma.This is one of the longest long-term reported intervals of a mature teratoma after treatment of a testicular nonseminoma germ cell tumor. This case emphasizes the necessity for follow up of testicular cancer throughout the patient's life.The prognosis for nonseminomatous germ cell tumor (NSGCT) of the testis has been dramatically improved by using a treatment protocol of cisplatin-based chemotherapy followed by surgical resection of residual tumor mass. The complete response rate of disseminated germ cell tumor with this protocol is between 70%–80%.Most patients who relapse do so within the first year of therapy. Late relapse is defined as recurrence after a relapse- free interval of more than two years after completion of primary treatment [1]. The cumulative risk of late relapse in patients appearing relapse -free at two years after first line chemotherapy is 4% in ten years [2].The incidence of late relapse after cisplatin based chemotherapy of germ cell tumor is related to initial tumor burden and patients with bulky retroperitoneal disease appear to be at an increased risk of late relapse. As tumor markers do not rise in one quarter of late relapses, they should undergo CT scans at annual follow-up evaluations. In the remaining patients, history, physical examination, tumor markers and chest X-ray may allow to detect the majority of late asymptomatic relapses [2].Herein we report a case of late relapse of a bulky teratocarcinoma, 17 years after completion of treatment as a mature teratoma of the neck and upper thorax.A 36 year-old man was admitted to our hospital with chief compl