精索横紋筋肉腫の1例

Abstract

19歳男.主訴は左鼠径部腫瘤.CTで左鼠径部に4×4×2.5cm大の腫瘤を認め, 辺縁整, 筋組織と比較し軽度low density, 内部は均一であり, 後腹膜リンパ節, 鼠径リンパ節に腫大を認めなかった.全身麻酔下に腫瘍摘出術を施行した.鼠径管を開くと腫瘍は精索上に存在し, 容易に周囲組織から剥離されたので腫瘍摘出術のみで手術を終了した.病理所見はAlveolar Rhabdomyosarcomaで, 腫瘍の精索付着側の断端は陽性であった.後日, 左高位精巣摘除術を施行し, 鼠径管周囲の筋組織も一塊として切除した.病理組織学的には腫瘍組織の残存は認めず, IRSのgroup Iに分類された.術後VAI療法を合計6コース施行し, 厳重に経過観察を行っているが, 現在再発を認めていない

A 19-year-old man visited our hospital complaining of swelling of the left inguinal region. A thumb head-sized tumor was palpated through the skin on the left spermatic cord. Tumor resection was performed because it was dissected easily apart from the left spermatic cord. Pathological examination revealed alveolar rhabdomyosarcoma with positive surgical margin. Computed tomographic scanning revealed no retroperitoneal lymph node swelling, and there were no clinical findings of distant metastasis (clinical stage I). Radical inguinal orchiectomy with combined chemotherapy using vincristine, dactinomycin, and ifosfamide (VAI) was performed. He has been alive without any recurrence for 8 years and 8 months after the surgery.