精巣摘除後に骨単独転移で再発したSeminomaの1例

Abstract

41歳男性.患者は左精巣腫瘍(seminoma, stage I)に対する左精巣摘除術後1年3ヵ月目に左上肢尺側の疼痛, 歩行困難が出現し, 精査加療目的で著者らの施設へ紹介入院となった.入院時, 腫瘍マーカーでhCG-βの上昇を認め, MRIでは第1胸椎体にT1にて低信号域の病変, 左神経根への浸潤を認め, 骨シンチグラムでは第1胸椎体および右坐骨に異常集積がみられた.生検の結果, seminomaの骨単独転移と診断し, 化学療法2コースと局所放射線療法を行ったが, hCG-βは陰性化せず, 末梢血幹細胞輸血併用大量化学療法を2コースを追加した.以後, hCG-βは陰性化し, 胸椎, 右坐骨の転移巣の消失を認め, 神経症状は独歩可能なまでに回復した

A 40-year-old man with stage I left testicular seminoma who had been followed for 18 months after orchiectomy, complained of pain in his left upper extremity and dysbasia. Magnetic resonance imaging (MRI) and bone scintigraphy suggested multiple bone lesions in the thoracic vertebrae and right ischium, and bone biopsy revealed metastasis of seminoma. There was no evidence of other metastatic lesions. After he was treated with 2 courses of first-line chemotherapy consisting of peplomycin, etoposide, and cisplatin, which were followed by 2 courses of high-dose chemotherapy with carboplatin, etoposide, and ifosfamide, the metastatic lesions were nearly in complete response on MRI and bone scintigraphy and the result of fluorodeoxyglucose-positron emission tomography was negative, but the hCG-beta level remained slightly elevated. In most advanced testicular tumors, bone metastasis usually coexists with other metastatic lesions and appears as a secondary lesion. Herein, we report this rare case of primary and solitary bone metastasis from testicular seminoma after orchiectomy.