Near-complete resolution of tumour thrombus in a patient with advanced non-seminomatous germ cell tumour: a multidisciplinary approach without surgical intervention

Non-seminomatous germ cell tumours are aggressive testicular malignancies that can rarely present with intravascular tumour thrombus, a complication associated with significant morbidity and complex management. We report a young man with a mixed non-seminomatous germ cell tumour who presented with pulmonary embolism and a large tumour thrombus extending from the inferior vena cava to the right atrium and pulmonary veins. Due to haemodynamic instability, he received therapeutic anticoagulation and an abridged 'cycle 0' chemotherapy regimen, followed by standard bleomycin, etoposide and cisplatin and delayed orchiectomy. Despite the extent of vascular involvement, near-complete resolution of tumour thrombus was achieved without surgical thrombectomy. This case highlights the potential for medical therapy alone in select non-seminomatous germ cell tumours and underscores the importance of early systemic treatment and multidisciplinary coordination. We also detail key complicating features such as suspicion of antithrombin consumption challenging our anticoagulation strategy to inform management strategies.