[A case of metastatic extradural seminoma suspected intradural invasion by the measurements of HCG beta concentration in CSF].

A 34-year-old man underwent left orchidectomy for his left testicular seminoma. One month later, he developed paraplegia, hypesthesia under Th10 level and vesicorectal disturbance. He was diagnosed as having compressive myelopathy secondary to metastatic neoplasm at thoracic vertebra 10 and its extradural space which were revealed on magnetic resonance imaging. After administration of combination chemotherapy with cisplatin, etoposide and bleomycin, the extradural lesions diminished and the neurological symptoms gradually improved. In this case, intradural invasion of tumor cells was suspected because the level of human chorionic gonadotrophin beta subunit (HCG beta) concentration in cerebrospinal fluid (CSF) was higher than that in plasma, while radiographic scanning demonstrated regional tumor located at extradural space of Th10 level. It is important to evaluate the spread of tumor cells for the choice of therapy and the monitoring of HCG beta (plasma:CSF ratio) was considered to be one of the useful methods to detect the presence of central nerve system metastases from HCG-producing tumor.