Is期睾丸混合性生殖细胞瘤不同治疗方法研究(附3例报告)

目的:本文旨在探讨Is期睾丸混合性生殖细胞瘤的不同治疗方法。方法:对2008年2月至2012年6月收治3例(年龄26~39岁)入院的Is期睾丸混合性生殖细胞瘤患者的临床资料进行回顾性分析和总结,并结合文献就该期肿瘤的临床特征进行探讨。结果:3例患者中1例只行根治性睾丸切除术,1例行根治性睾丸切除术+腹膜后淋巴结清扫术+BEP方案化疗,1例行根治性睾丸切除术+放疗。混合性生殖细胞瘤病理成分分别为左侧95%未成熟畸胎瘤、精原细胞瘤合并5%绒癌、胚胎性癌成分,左侧75%精原细胞瘤合并25%胚胎性癌、畸胎瘤成分,右侧90%成熟性畸胎瘤合并10%卵黄囊瘤。随访24个月3例患者肿瘤无局部复发和远处转移。结论:对于Is期睾丸混合性生殖细胞瘤诊断主要依靠体格检查、超声、MRI、血清肿瘤标记物测定等,确诊需要病理学检查,根治性睾丸切除术是其基础的治疗方法。     

睾丸混合性生殖细胞瘤1例报告

在过去的30年,睾丸肿瘤的发病率在西方主要工业国家为2.5/10万～9.2/10万不等[1].由于病例少见,所以临床对睾丸肿瘤的规范化诊疗认识尚不充分,据统计有1/4的患者从出现症状到行睾丸切除,已经延误治疗约半年左右[2].本科于2008年12月收治睾丸混合性生殖细胞瘤患者1例,现结合文献,报告如下.     

Ⅰ期睾丸混合性生殖细胞瘤的诊断与治疗(附2例报告)

<正>过去的30年,睾丸肿瘤的发病率在西方主要工业国家为25/10万～92/10万[1],由于睾丸混合性生殖细胞瘤临床罕见,对其诊疗认知不足,有1/4患者从出现症状到睾丸切除,已延误治疗半年左右[2],我院2006年9月及2011年7月收治2例,结合文献讨论其诊疗方法。     

原发性睾丸附件恶性纤维细胞瘤1例报告并文献复习

目的:探讨原发性睾丸附件恶性纤维细胞瘤的临床表现、影像学特点、病理特征、治疗及预后。方法:报告1例原发性睾丸附件恶性纤维细胞瘤情况:患者男,年龄63岁。因"复发性左侧阴囊内无痛性肿物2年"求治。检查AFP为16ng/ml,β-HCG为0.44mIU/L。B超检查提示左侧阴囊内占位性病变(恶性肿瘤可能性大)。经左侧腹股沟切口行左侧阴囊探查+睾丸根治性切除术。结果:病理检查报告为(睾丸附件)恶性纤维组织细胞瘤,瘤组织未侵及睾丸,输精管切缘未见瘤细胞。免疫组织化学:CD68+,Desmin+++,Vimentin++,CK-,S-100-,Actin-。术后未行局部放疗及化疗。随访15个月,CT复查无局部肿瘤复发及远处转移表现,患者生存质量良好,目前仍在继续随访中。结论:原发性睾丸附件恶性纤维组织细胞瘤临床表现及影像学表现缺乏特征性,确诊依靠术后病理学检查,手术切除+术后辅助化疗为有效治疗方法。     

晚期睾丸癌的治疗应基于风险分级

30年期间睾丸生殖细胞瘤的治疗在不断变化,现在大部分患者都能长期存活.     

睾丸肿瘤腹膜后淋巴清除术的改进

腹膜后淋巴清除术是睾丸肿瘤手术疗法的重要环节。但常规的RPLND有一定的并发症,特别是引起射精功能障碍和不育症,使青壮年患者难于接受。多年来,甚多学者从事这方面的研究,提出了一些改进方法,现综述如下: 一RPLND的适应症根据睾丸组织发生的不同,睾丸肿瘤可区分为生殖细胞瘤、非生殖细胞瘤和转移性睾丸肿瘤。其中生殖细胞瘤最为常见,占睾丸所有肿瘤的95%。按WHO的分类法,睾丸生殖细胞瘤又可分为精原细胞瘤和非精原瘤性生殖细胞瘤(简称NSGCTT)。精原细胞瘤较多见,占生殖细胞瘤中的45%。其生物学特性     

患生殖细胞瘤的无精子症病人于化疗前进行睾丸精子抽提:一种新的治疗选择

目的　由于睾丸生殖细胞瘤具有较高的治愈率 ,临床研究的重点已转向如何保护病人的生育能力。临床化疗应用顺铂累积剂量大于 0 .6 g/m2 足以导致 5 0 %以上的病人长期不育。保护肿瘤患者生育力的标准治疗程序之一 ,是对射出精子进行冷冻保存。然而 ,考虑到肿瘤在部分病人可引起无精子症 ,作者考察了化疗前进行睾丸精子抽提的实用性。方法　作者评述了已往文献 ,作为研究化疗对男性生育力影响的生物学和临床依据 ;并对 14例睾丸生殖细胞瘤而无精子的患者于化疗前进行了对侧健康睾丸的精子抽提。结果　在 14例化疗前的睾丸活检中 ,成功取回了 …     

单侧大细胞钙化型支持细胞瘤合并弱精子症1例报道并文献复习

大细胞钙化型支持细胞瘤属于睾丸非生殖细胞瘤分类中十分罕见的性索间质肿瘤,目前仍未见合并弱精子症的报道,本文以我院收治1例大细胞钙化型支持细胞瘤合并弱精子症患者临床资料为基础,查阅相关资料对其进行回顾性文献复习并探讨大细胞钙化型支持细胞瘤的临床诊治策略及该病与弱精子症的联系。     

睾丸肿瘤66例临床分析

198 4年 6月至 1998年 4月我院共收治睾丸肿瘤 6 6例 ,现报告如下。材料与方法　本组 6 6例。年龄 14个月～ 84岁 ,平均 36岁 ;<5岁者 10例 ,均为胚胎癌 ;5～ 18岁者 1例 ,为横纹肌肉瘤 ;18～ 4 0岁者 4 4例 ,其中精原细胞瘤 2 5例 ,胚胎癌 6例 ,良性畸胎瘤 3例 ,恶性 (恶变 )畸胎瘤 6例 ,混合性生殖细胞瘤 2例 ,脂肪瘤、间质细胞瘤各 1例 ;>4 0岁者 11例 ,其中精原细胞瘤 8例 ,纤维性假瘤、交界性纤维细胞瘤、睾丸皮下腺癌浸润各 1例。左侧 30例 ,右侧38例 ,双侧 2例。有隐睾病史者 6例 (均为精原细胞瘤 )。6 6例均手术治疗。 2例良性肿瘤…     

Survivin在睾丸生殖细胞瘤与无精子症患者睾丸组织中的表达

目的：探讨Survivin蛋白在睾丸生殖细胞瘤与无精子症患者睾丸组织中的表达情况及其临床意义。方法：采用免疫组织化学SABC法检测34例男性睾丸生殖细胞瘤和38例男性无精子症患者睾丸组织中Survivin蛋白的表达情况。结果：18例睾丸精原细胞瘤和16例非精原细胞瘤组织标本中Survivin蛋白的表达情况分别为88．9％和62．5％；在38例不同类型无精子症睾丸组织标本中，各组间Survivin蛋白的表达差异有统计学意义（P〈0．05），且表达情况与生精功能障碍严重程度呈负相关（r=-0．675，P〈0．05）。结论：在睾丸生殖细胞瘤和正常睾丸组织中可检测到Survivin蛋白的表达，Survivin蛋白可能是精子发生过程中的一个潜在标志物。     

Retroperitoneal germ cell tumor with testicular calcification indicating tiny testicular origin: consideration of the origin of retroperitoneal germ cell tumors: report of two cases

Two cases of germ cell neoplasm retrospectively considered to have been of testicular origin are reported. Case 1. A 19-year-old male with brain, liver and retroperitoneal tumors was diagnosed with yolk sac tumor by retroperitoneal tumor biopsy. After multidisciplinary treatment, a region of calcification was detected in the left testis on scrotal sonography and left high inguinal orchiectomy was performed. Case 2. A 57-year-old male with neck, lung and retroperitoneal tumors was diagnosed with yolk sac tumor by supraclavicular biopsy. From initial examination, scrotal sonography revealed a small calcified lesion in the right testis. After chemotherapy, high inguinal orchiectomy and retroperitoneal lymphadenectomy were simultaneously performed. Pathologic evaluation of these testicular specimens revealed calcification and a fibrous scar in correspondence with the clinical diagnosis. These changes were considered as scars of the primary testicular tumor due to burned-out tumor or the result of reaction to chemotherapy. Since a primary tumor of testicular origin may exist in the extragonadal germ cell tumor, it is important to examine the intrascrotal contents in detail in the case of so-called extragonadal germ cell tumors with palpably normal testes. In such cases, there are two possible conditions, an occult testicular tumor and a burned-out testicular tumor. We briefly reviewed 42 such cases in the Japanese literature. It appears that there are very few true extragonadal germ cell tumors, and that the possibility of primary testicular origin metastasizing from viable occult testicular tumor or burned-out testicular tumor with spontaneous regression is high in retroperitoneal germ cell tumors.     

A case of retroperitoneal bulky tumor with cryptorchidism

A 37-year-old male was presented with an upper abdominal mass. A retroperitoneal bulky tumor was detected and operative biopsy revealed seminoma. The right testis was undescended and atrophic which was located at the left inguinal lesion. Pathologically, the primary tumor cells were not found in the left orchiectomied testis, but only scar and fibrosis were compatible with a burned-out testicular tumor. This patient showed partial regression by multidisciplinary therapy including combined chemotherapy with CDDP, etoposide and peplomycin, and is still on the same condition and alive for 3 years. In case of extragonadal germ cell tumor without apparent testicular involvement, it is a problem to differentiate primary extragonadal germ cell tumor from occult and burned-out testicular tumor. Testis should be examined by all means available including careful exploration.     

Signet ring cell carcinoma of the testis: clinicopathologic and molecular evidence for germ cell tumor origin--a case report

Development of a somatic-type malignancy from a mixed germ cell tumor is a rare but recognized event and typically represented by sarcoma or, less commonly, by carcinoma. This phenomenon is generally believed to result from progression of a teratomatous component. In many cases, because of intermingling of other germ cell tumor components, the diagnosis is apparent; however, in rare cases, metastatic carcinoma to the testis or a novel primary tumor may be a diagnostic consideration. In this study, we report the clinicopathologic, immunohistochemical, and molecular features of a 53-year-old man, whose testicular tumor was composed entirely of signet ring cells, mimicking metastatic carcinoma. Subsequent retroperitoneal lymph node dissection revealed metastatic deposits composed of teratoma and yolk sac tumor, in addition to signet ring cell carcinoma. Fluorescence in situ hybridization for abnormalities of chromosome 12p revealed the presence of i(12p) in both the teratoma and signet ring cell carcinoma in the metastasis and in signet ring cells in the testis, supporting a common germ cell origin. Our report indicates that signet ring carcinoma cells in an orchiectomy specimen, although usually strongly suggestive of metastatic adenocarcinoma from a primary tumor in another organ, may be a primary testicular neoplasm of germ cell tumor origin. This is the first report of testicular signet ring cell carcinoma of germ cell tumor derivation.     

Classification and pathology of testicular germ cell and sex cord-stromal tumors.

Germ cell tumors of the testis are the most frequent testicular neoplasms, with seminoma predominating. The pathologist must be able to discriminate between seminoma and nonseminomatous germ cell tumors as well as sex cord-stromal tumors and metastatic lesions. Appropriate therapy and accurate prognostic information are dependent on the proper classification of testicular neoplasia. Characteristic histologic features, serum markers, and immunohistochemistry are helpful in this regard. Sex cord-stromal tumors comprise a small minority of testicular neoplasms. It remains critically important not to confuse these neoplasms with testicular germ cell or metastatic tumors, and, again, recognition of the characteristic histologic features, immunohistochemical findings, and clinical information is diagnostic. The urologist can provide the pathologist with key clinical information in the attempt to make a correct diagnosis.     

Testis sparing surgery for the treatment of a sequential bilateral testicular germ cell tumor

Standard therapy of sequential bilateral testis cancer is generally considered to be orchiectomy. We present a case of sequential bilateral testicular germ cell tumor treated with testis sparing surgery. The patient was disease free 50 months after surgery without local recurrence or distant metastases. Testis sparing surgery provides a better quality of life and may be considered a safe, feasible alternative in the treatment of carefully selected patients with bilateral testicular germ cell tumor.     

Intra-abdominal desmoid tumor following retroperitoneal lymph node dissection for testicular germ cell tumor

In the testicular cancer post-treatment setting a rapidly growing retroperitoneal mass leads to a differential diagnosis including recurrent germ cell tumor, residual mature teratoma, or sarcomatoid degeneration. We report the case of a 27-year-old man with a large abdominal mass occurring in the setting of a mixed germ cell tumor after radical orchiectomy with primary chemotherapy followed by retroperitoneal lymph node dissection. Surgical excision of this mass followed by pathological review revealed an intra-abdominal desmoid tumor. Fluorescence in situ hybridization (FISH) for isochromosome 12p failed to demonstrate a germ cell tumor origin. This is the fourth such case of an intra-abdominal desmoid tumor after retroperitoneal lymph node dissection for testicular cancer in the urologic literature. This case highlights the need for careful consideration of a desmoid tumor when a rapidly growing spindle cell tumor is encountered in a post-treatment testis cancer patient.     

Testicular germ cell tumor arising in the male with a chromosomal abnormality of 45,X/46,X,del(Y)

A 25-year-old-man came to our outpatient clinic complaining of swelling of the left scrotal contents. He had a past history of 3 surgeries for hypospadia. His left testis was stony hard and testicular tumor was suspected. High orchiectomy was performed under general anesthesia. The pathological diagnosis was mixed type testicular germ cell tumor. Chromosomal analysis revealed a karyotype of 45,X/46,X,del(Y). Most of the long arm of the Y chromosome was missing. Prophylactic chemotherapy was performed. Treatment options for genetically high risk patients of testicular malignancies were discussed.     

睾丸生殖细胞肿瘤62例临床分析

目的：探讨睾丸生殖细胞肿瘤的诊断、治疗、预后情况及对性功能的影响。方法：对1992年3月～2006年4月收住院的睾丸生殖细胞肿瘤患者的临床及随访资料进行回顾性分析和总结。结果：精原细胞瘤（sGCT）患者平均发病年龄40．3岁,比非精原细胞瘤（NSGCT）大6．9岁;B超显示,SGCT多表现为低回声,NSGCT多为不均匀回声;两者5年总生存率分别为93．94％、82．35％;疾病或治疗相关性性功能障碍发生率14．29％。结论：①血清肿瘤标志物、超声、腹部CT检查对于睾丸生殖细胞肿瘤的诊断、临床分期及预后判断有一定参考价值。②SGCTI期患者单纯手术与手术加放疗疗效相当,Ⅱ期患者应给予手术加放疗;NSGCT患者应给予手术加化疗等综合治疗。③睾丸肿瘤及相关治疗对性功能影响较小,勃起功能障碍主要与放疗有关。     

A rare simultaneous presentation of testicular mixed germ cell tumor with a contralateral testis torsion

We report a rare case of a 27-year-old man presenting with an acute scrotum with simultaneous occurrence of testicular tumor and contralateral torsion. Preoperative imaging demonstrated the testicular missed torsion, yet findings were equivocal with regard to the testicular tumor. On scrotal exploration the left testis was found to be ischemic due to threefold rotation. The right testis was not identifiable, being composed of numerous necrotic lesions. Frozen section suggested malignancy, hence high right orchiectomy was performed. Histologic examination of the right testis showed mixed germ cell tumor, containing all the subtypes. To our knowledge no similar case has been reported.     

Acute scrotum due to arterial bleeding mimicking non-seminomatous germ cell tumor

Men with testicular tumors usually present with painless increase in testis size incidentally noticed by the patient. We report a case of a young patient presenting as an emergency with acute onset of massive right-sided testicular pain without previous injury. After physical examination testicular torsion could not be excluded. Ultrasound examination of the tesds was suspicious for tesdcular tumor. Surgical exploration of the right testis by inguinal approach was performed revealing subcapsular arterial bleeding due to a small nonseminomatous germ cell tumor non-palpable on clinical examination. (Asian J Andro12004 Dec;6:379-381)