Late relapse of testicular cancer 21 years after first complete remission: a case report.

We report here a case of very late relapse of a nonseminomatous germ cell tumor 21 years after first complete remission. A 42-year-old man, with a clinical history of right testicular cancer, was referred to our hospital with elevated serum alpha-fetoprotein (AFP) level. CT scan demonstrated a 5 x 5 cm retroperitoneal lymph node swelling compressing the inferior vena cava (IVC) extending from the right renal vein down to the bifurcation of the aorta. The patient received a total of four courses of combination chemotherapy consisting of cisplatin, etoposide, paxlitaxel, and ifosfamide. However, the retroperitoneal lymph node metastasis did not respond to chemotherapy, and the serum AFP level increased. Extended bilateral retroperitoneal lymph node dissection with right nephrectomy, partial duodenectomy, and vena cavectomy were performed. The patient has been followed up with no evidence of disease for 48 months after the operation without any further therapy.