EXTRAGONADAL GERM CELL TUMOR IN AN OLDER PATIENT. NOT EVERY MASS IS A “LUNG CANCER”

Background: Extragonadal germ cell tumors are rarely diagnosed beyond the fourth decade of life. Here, we present an unusual case of an older patient with a rapidly growing lung mass and a significantly elevated beta-HCG consistent with an extragonadal germ cell tumor. Case presentation: A 69 year old male was found to have multiple brain lesions and a lung mass. He was initially diagnosed with stage IV poorly differentiated non?small cell lung cancer. A germ cell tumor was suspected due to its rapid growth and a highly elevated serum beta-HCG was found. Testicular ultrasound was negative for a gonadal mass. AFP was not elevated. There was no isochromosome 12p but there was hyperdiploidy of chromosome 12. He was treated with platinum based chemotherapy. He had an initial transient decline in the beta-HCG levels along with radiographic improvement but the disease progressedrapidly. Conclusion: Extragonadal germ cell tumors should be suspected in older patients with a lung mass and a rapid tumor progression.