初診時に胃・腎・皮膚をはじめとする多臓器転移を認めた精巣腫瘍の1例

Abstract

39歳男.全身倦怠感, 血痰を主訴とした.約半年後に近医を受診し, 左精巣腫瘍, 及び多発性肺転移の診断で左精巣高位摘除術を受けた.病理組織診断は絨毛癌であった.術後, 化学療法目的で来院した.頭皮・左頬部・前胸部には出血を伴う3cm大, 弾性硬, 黒色の皮膚腫瘤を認めた.胸部X線, 胸部CT, 頭部CT, 腹部CT, 上部消化管内視鏡検査では両肺の結節影, 左小脳半球の高濃度病変, 肝S7の低濃度域, 両腎の結節病変, 胃後壁の粘膜下腫瘤を認めた.BEP療法(ブレオマイシン・エトポシド・シスプラチン), EP療法(エトポシド・シスプラチン), TIP療法(パクリタキセル・イホスファミド・シスプラチン)などを行った.小脳転移に変化はなかったが, 肺転移は縮小傾向, 肝・腎・胃・皮膚転移は消失し, 腫瘍マーカーも正常化した.しかし, β-ヒト絨毛性性腺刺激ホルモンの再上昇がみられ, TIP療法, Nedaplatin+塩酸イリノテカン療法, γナイフ療法を行ったが, 脳転移巣の増大・出血による神経症状, 肺転移巣の増大を認め, 術後17ヵ月目に死亡した

A 39-year-old man whose chief complaints were general fatigue and bloody phlegm was diagnosed with testicular cancer and underwent left high orchiectomy at an affiliated hospital. The histopathologic diagnosis was chorio carcinoma. Several imaging examinations revealed the metastases in the lung, liver, brain, stomach, kidneys and skin. In spite of various chemotherapies, he died 17 months after the operation. Skin metastasis of testicular cancer is very rare and this is the twelfth case reported in the world, to our knowledge. The significance of skin metastasis in testicular cancer is discussed.