The patient was a 18-year-old adolescent with a nonseminomatous germ cell tumor of the right testicle, with the presence of pulmonary, liver, and massive retroperitoneal metastases. Following radical orchiectomy, the patient started chemotherapy according to the BEP protocol (without routine prophylaxis for DVT). On day 4 of the first cycle, massive DVT was diagnosed, extending from both popliteal veins up to the thoracic segment of the inferior vena cava. Thrombolytic therapy with streptokinase was immediately started. On day 2 of thrombolytic therapy, the patient developed acute renal failure, due to extension of the thrombosis to the renal veins. Streptokinase was continued for six days and the outcome was remarkably favorable.

O caso de um paciente do sexo masculino com 54 anos, portador de carcinoma de pequenas Células primitivo em terço inferior de esôfago. As manifestações iniciais da doença se caracterizaram por emagrecimento acentuado e dores epigástricas com 3 meses de evolução. Ao exame físico observamos sinais evidentes de doença consuntiva. O estadiamento oncológico revelou acometimento secundário de linfonodos para-aórticos, mesentéricos e do tronco celíaco (doença extensa), além de possível invasão de aorta descendente. O tratamento baseou-se na quimioterapia com cisdiaminodicloroplatinum e etoposide, obtendo-se remissão clínica completa com três ciclos. Como consolidação do resultado, o paciente recebeu radioterapia externa dirigida ao local do tumor primário, porém a resposta obtida não se manteve, havendo progressão local e sistêmica após 40 dias do término da radioterapia. O óbito se deu em função de infecção respiratória e múltiplas metástases 9 meses do diagnóstico. Nós discutimos o mau prognóstico deste tipo de tumor, sobretudo em função do comportamento biológico agressivo e fazemos uma análise crítica da orientação terapêutica proposta, concluindo que o tratamento principal para os carcinomas de pequenas células de esôfago locorregionalmente avançado deve ser baseado na quimioterapia.

The authors report a case of an extensive deep venous thrombosis occurring as a complication of chemotherapy with cisplatin, bleomycin and etoposide for a testicular germ cell tumour. During the first cycle of chemotherapy, the patient developed a dramatic picture of deep venous thrombosis, extending from the popliteal and iliofemoral veins up to the thoracic vena cava, close to the right atrium. Progression of thrombosis to the renal veins resulted in acute renal failure requiring dialysis. There are no reports in the literature of such an extensive thrombosis associated with this regimen. Of note, the remarkable results obtained with the early institution of thrombolytic therapy with streptokinase. Thromboembolic events are potentially lifethreatening complications that seem to occur more frequently than expected in patients receiving chemotherapy for germ cell tumours, in spite of young age. Preventive measures should not be overlooked in this setting. LIST OF ABBREVIATIONS GCT= germ cell tumours CMF= cyclophosphamide, 5-fluorouracil, methotrexate CMF/tam= cyclophosphamide, 5-fluorouracil, methotrexate, tamoxifen DVT= deep venous thrombosis BEP = bleomycin, etoposide, cisplatin TT= thrombolytic therapy DHL= lactate dehydrogenase β-hCG= human chorioninc gonadotropin β-subunit AFP= alphafetoprotein IV= intravenously RP= Raynaud phenomenon SH= systemic hypertension PVB= cisplatin, vinblastin, bleomycin FSH= follicle stimulating hormone LH= luteinizig hormone PTE= pulmonary thromboembolism