塩酸イリノテカン・シスプラチン併用療法が奏効した両側同時性異組織型難治性精巣腫瘍の1例

Abstract

38歳男.両側陰嚢腫大, 体重減少を主訴とした.左頬部, 上腹部に腫瘤を触知した.両側精巣は共に小児頭大, 弾性硬であり, 腫瘍マーカーは高値を示した.超音波エコーは両側精巣とも充実性腫瘤像を, 胸部CTは左頸動脈リンパ節腫大を, 腹部CTは傍大動脈リンパ節腫大を示した.両側精巣腫瘍stage IIIAと診断し, 両側高位精巣摘除術を行った.右はseminoma, embryonal carcinoma, yolk sac tumor, immature teratoma, 左はseminomaであった.術後, BEP療法(ブレオマイシン・エトポシド・シスプラチン)により腫瘍マーカーは低下した.しかし, 右肺, 続いて左肺に精巣腫瘍の肺転移を疑う病変を認め, EP療法(エトポシド・シスプラチン)やシスプラチン+イリノテカン療法を行った.その結果, 腫瘍マーカーは低下し, 肺転移巣は消失した.その後, 2型糖尿病が発見され, 血糖コントロール実施の上, 後腹膜リンパ節郭清術を行った.術後11ヵ月以上が経過したが, 再発は認められない

A 38-year-old man was admitted to our hospital complaining of bilateral scrotal swelling. On examination, the patient was found to have bilateral testicular tumors with jugular chain lymph node and para-aortic lymph node metastasis. He underwent bilateral inguinal orchiectomy. Histopathological examination of the excised tumors revealed seminoma, embryonal carcinoma, yolk sac tumor and immature teratoma in the right testis and seminoma in the left testis. The patient was treated postoperatively with two courses of BEP (bleomycin, etoposide, cisplatin) therapy and two courses of EP (etoposide, cisplatinum) therapy. The patient had lung metastasis during the follow-up period and we treated him with salvage combination chemotherapy of cisplatin and irinotecan hydrochloride (CPT-11). After the third course of cisplatin and CPT-11 chemotherapy the lung metastasis disappeared and we performed retroperitoneal lymph node dissection. The patient has remained free of disease 11 months after discharge.