停留精巣に発生した巨大セミノーマの1例

Abstract

25歳男性.患者は左膝疼痛, 左下肢痺れを主訴に受診となった.症状より血行障害を疑われ, ドプラーエコーを施行したところ, 脛骨動脈の流量低下を認められた.そこで, 造影CTおよび3D-CTを行なったところ, 造影効果の低い巨大な腹腔内の腫瘍および腫瘍への栄養血管を認めた.血液生化学所見ではLDHおよびALPの高値を認め, 腹部正中切開で腫瘍摘出術施行した結果, 径25×18×12cm, 重量3000gの表面平滑な腫瘍および黄色混濁の腹水を認め, 細胞診検査でclass Vであった.腫瘍は被膜に覆われた左精巣動静脈をfeeding artery, drainage veinとしており, その時点で初めて左陰嚢内に精巣がないことが認識された.病理組織診断で精上皮腫(seminoma), 一部被膜外への浸潤を認めた

A 26-year-old man was admitted to the department of surgery of our hospital with a complaint of intermittent left leg pain for the past two weeks. Ultrasonography revealed reduced blood flow to the tibial artery, which suggested a vascular disease like arteriosclerosis obliterans. Enhanced computed tomography (CT) revealed a huge abdominal tumor and a 3-dimensional CT scan showed a feeding artery from the left renal artery to the huge tumor. Findings of routine blood and urine examinations were elevated levels of lactate dehydrogenase, alkaline phosphatase, and C-reactive protein. Surgical exploration revealed a giant tumor with clouded ascites in the abdominal cavity containing class V cells revealed by cytological examination. The tumor was easily resected. Its vascular pedicle was thick and hypertrophied. Thus, it could be traced to the origin of left gonadal artery. At this time, the surgeon incidentally noticed the absence of left testis in the patient's scrotum. The resected specimen was 25 x 18 x 12 cm in size, and it weighed 3000 gm. The histological finding was pure seminoma invaded to peritoneum. His leg pain was relieved after the tumor resection.