精巣腫瘍治癒過程でAFP高値が遷延した2症例

Abstract

症例1(42歳男性).患者は他院で左精巣腫瘍(seminoma)の高位除精術を受け, その3年後にseminoma縦隔転移で化学療法を施行した.腫瘤は縮小したが, 肝機能障害およびAFP高値(40ng/ml)遷延し, 今回紹介入院となった.C型肝炎の活動性上昇からAFPのLCA分画測定を行い, 化学療法による肝機能障害でC型肝炎の活動性が惹起されAFPが上昇したとの判断で経過観察とした.その結果, 10ヵ月経過現在, AFPは13.4ng/mlまで下降した.症例2(30歳男性).患者は左精巣腫大で紹介入院となり, AFPは45ng/mlであった.左高位除精術を行なったところ, 病理診断ではceminomaであった.化学療法後もAFPは29.1ng/mlで, LCA分画測定結果から更に化学療法を追加した結果, AFPに変化なかったものの, 化学療法休薬中にもAFPは上昇せず経過観察となった.2年経過現在, AFPは20ng/ml台で推移しており, 再発は認められていない

Two patients with testicular tumors whose serum alpha-fetoprotein (AFP) persisted to show an abnormally high concentration are reported. Case 1 : A 42-year-old male who had been suffering from chronic hepatitis, underwent left high orchiectomy for a left testicular tumor in 1998. Diagnosis was an authentic stage I seminoma. In 2002, chemotherapy was performed for a metastatic seminoma revealed as a solitary mass in the mediastinum by radiographic studies, and histologically confirmed to be a metastatic seminoma. Although lymph nodes were gradually reduced in size, the serum AFP and transaminase levels remained at an abnormally high concentration. The subfraction profile with lens culinaris hemagglutinin (LCA) revealed elevation of only peak 1 which implied that the chronic hepatitis was due to liver dysfunction. After a 10-month follow-up the levels of both AFP and transaminase decreased, and the patient was disease-free. Case 2: In 2002, a 30-year-old male underwent left high orchiectomy for a left testicular tumor, and histological examination revealed seminoma, immature and mature teratoma, embryonal carcinoma. The serum AFP was elevated to 45 ng/ml. Diagnosis was authentic stage I. After 2 courses of chemotherapy, the serum AFP remained at an abnormally high concentration. However, there were no new lesions. The serum AFP level was not elevated in any of the family members. The subfraction profile with LCA revealed elevation of only peak 1, which implied that there were no viable lesions. After a 24-month follow-up AFP was about 20 ng/ml and the patient was disease-free.