Unusual metastatic pattern in testicular malignant teratoma

A 25-year-old man presented with a malignant teratoma of the right testicle. After orchidectomy, the results of the surgical staging procedure were negative. Although pulmonary metastasis did not occur, massive bone marrow involvement with a bleeding tendency and hypercalcemic nephropathy developed. The response to chemotherapy was excellent, but after the attainment of a complete remission the patient developed carcinomatous leptomeningitis, which was confirmed at autopsy as cause of death.