組織型の異なった同時性両側精巣腫瘍の1例

Abstract

22歳男.発熱, 背部痛, 右陰嚢内容腫大を主訴とした.超音波検査, MRI, CT各所見より, 両精巣腫瘍(右5cm, 左1.5cm), 後腹膜リンパ節転移と診断し, 両側高位精巣摘除術を行った.術後, 追加療法としてBEP療法を行った.病理学的に右精巣はセミノーマで, 左精巣は胎児性癌であった(両側ともpTlN3M0).その後, 他病院にて後腹膜リンパ節郭清術を行い, テスステロン補充療法を行いつつ経過観察中である.術後16ヵ月現在, 再発は認めない.なお, 本症例は同時性両側異組織精巣腫瘍に分類にされるが, 発見時期による分類については, 今後の検討が必要であると思われた

A 22-year-old man presented to our out-patient clinic with the chief complaint of a painless mass in the right scrotum and lymph node swelling around the abdominal aorta in October, 2002. The bilateral testicular tumors were palpated and visualized by ultrasound and magnetic resonance imaging (right phi5 cm, left phi2 cm in diameter). Computed tomography revealed a metastatic lymph node around the abdominal aorta (3 x 3 x 10 cm in size). He underwent bilateral radical orchiectomy after frozen storage. Enucleation of the left testicular tumor was not performed because of its irregular demarcation. Histological examination revealed typical seminoma of the right testis and embryonal carcinoma of the left testis. Retroperitoneal lymph node dissection was performed after 4 courses of systematic chemotherapy (bleomycin, etoposide, platinum). No viable tumor cells were present histologically in the excised lymph nodes. The postoperative course was good and uneventful at 16 months under androgen replacement therapy without disease recurrence.