術前2年目に孤立性に肋骨転移をきたしたセミノーマの1例

Abstract

32歳男性.患者は約2年前に右精巣腫瘍(病理検査ではセミノーマと診断)により高位精巣摘除術を施行した病歴があり, 今回, 左側背部痛が出現したために受診となった.所見では左第10肋骨部背側に超鶏卵大, 弾性硬の腫瘤が触知され, CTでは左第10肋骨起始部に腫瘤を認めた.更にMRIのT1強調像では同肋骨は軟部腫瘍に置き換わるように断裂し, T2強調像では高信号の腫大した軟部組織を横突起間近まで認めた.これらより吸引細胞診でセミノーマと診断し, セミノーマの肋骨への血行性転移と考え, BEP療法を行い62.5%の腫瘍縮小率を得た.しかし残存を疑い, 末梢血幹細胞移植併用の大量化学療法を加え, 左第10肋骨広範切除術を行なった結果, 現在も再発は認められていない

A 32-year-old man underwent orchiectomy for his right testicular tumor (pure seminoma, pT1, stage A(I)). Pelvic and para-aortic lymph nodes were irradiated with 18 Gy as adjuvant therapy. Two years later, he developed low back pain. Computed tomography, magnetic resonance imaging and bone scans showed an enhanced mass at the 10th left costa. Aspiration cytology showed seminoma. After administration of chemotherapy with bleomycin, etoposide and cisplatinum, following high dose chemotherapy with peripheral blood stem cell transplantation, the costal lesion was diminished and symptoms relieved. Then radical costectomy was performed. A histopathological study showed non-viable cells of seminoma. Post-operative progress was uneventful. Testicular pure seminoma with bone metastasis is rare, and to our knowledge, only 9 cases have been reported.