化学療法先行治療が奏効した広範な精索浸潤を伴う巨大精巣腫瘍の2例

Abstract

症例:55歳, 男性, CTで左鼠径部に10×9cm大の腫瘤と, 腎内部に13×10cm大の後腹膜リンパ節腫脹を認め, 両者の間に腫大した精索が連続していた.LDH 3.669μ/l, βhuman chorionic gonadotropin(β-hCG)1.3ng/mlと高値を呈し, 針生検で左鼠径部腫瘤はセミノーマであった.VIP療法を行い, 4コース後原発巣77%, 後腹膜リンパ節82%の縮小を得たが, 左高位精巣摘除術と後腹膜リンパ節郭清術を施行, 摘除組織は全て壊死又は線維組織であった.症例2:38歳, 男性.CTにて左鎖骨上リンパ節腫脹;腎門部から大動脈分岐部まで連続する11×8cm大の後腹膜リンパ節腫脹及び32×28×28cm大の左陰嚢内容の腫大とこれに連続して大動脈分岐部まで腫大する精索の腫脹を認め, 針生検でセミノーマであった.VIP療法後左高位精巣摘除術, 後腹膜リンパ節郭清術を施行.切除組織は全て壊死組織であった

The first case was a 55-year-old man with biopsy-proven seminoma of the left inguinal undescended testis. The tumor, 10 x 9 x 9 cm in size, with a calculated weight of 520 g invaded the left spermatic cord up to the level of the renal hilum and metastasized to the retroperitoneal lymph nodes (13 x 10 cm). The serum level of lactate dehydrogenase (LDH) and beta human chorionic gonadotropin (beta-hCG) was 3, 669 U/l and 1.3 ng/ml, respectively. The second case was a 38-year-old man with non-seminoma of the left testis. The testicular tumor, 32 x 28 x 28 cm in size, with a calculated weight of 7, 000 g invaded the left spermatic cord up to the level of the aortic-bifurcation and metastasized to the retroperitoneal and the left supraclavicular lymph nodes. The serum level of LDH, alphafetoprotein (AFP) and beta-hCG was 2, 040 U/l, 240 ng/ml and 5.6 ng/ml, respectively. Both patients were initially treated with VIP chemotherapy (etoposide, ifomide and cis-platinum), 4 cycles for the 1st case and 3 for the 2nd, and followed by high orchiectomy and retroperitoneal lymph node dissection. Histologic section of all resected specimens revealed only necrosis and fibrosis. The patients have been free of recurrence for 15 and 13 months, respectively, after the operation. In the Japanese literature, 42 cases of giant testicular tumor (> 400 g) including these two cases have been reported. To our knowledge, our second case is the largest among the non-seminomatous tumors. For giant testicular tumor with extensive invasion to the spermatic cord, initial chemotherapy followed by surgical resection appears to be a better management.