Desperation surgery for a chemorefractory lung lesion in a patient with an extragonadal germ cell tumor

We report a case of recurrent and chemorefractory extragonadal germ cell tumor successfully treated with desperation surgery. A 25-year-old man presented with a mediastinal tumor with multiple lung metastases. Serum human chorionic gonadotropin (hCG) level was elevated. He was diagnosed with a mediastinal germ cell tumor (GCT) with multiple lung metastases. After second-line chemotherapy, serum hCG levels normalized. After a total of 10 cycles of chemotherapy, the mediastinal tumor was resected, with no viable tumor detected in the resected tissue. One month after the resection, serum hCG increased, accompanied by the appearance of a new lesion in the lung. After various regimens of salvage chemotherapies, serum hCG failed to normalize. Then, salvage surgery for the lung metastasis was performed. The resected tissue contained a viable choriocarcinoma. The patient remained free of disease without adjuvant therapy at 38 months after pneumonectomy.