Burned-out testicular tumorと考えられた後腹膜胚細胞腫の1例

Abstract

29歳男.後腹膜リンパ節転移巣から発見され原発巣と考えられた左精巣には明らかなviable cellを認めず瘢痕組織のみであり, burned-out testicular tumorと考えられた1例であった.原発巣と考えられた左精巣には特に症状を認めなかった.しかし注意深い触診により萎縮した精巣と小結節を触知可能であり, 更に超音波検査により触診で触れた小結節と一致した部位の小エコー領域を認め, 原発巣検索に超音波検査は有用であった.精巣腫瘍stage IIBと考え, ブレオマイシン, エトポシド, シスプラチンを用いた併用化学療法を3コース施行した.ブレオマイシンによると思われる発疹が出現したため2コース目以降は他の2剤により治療した.残存する後腹膜腫瘍に対し手術を施行した.左腎は腫大リンパ節と強度に癒着し左尿管は腫大リンパ節に巻き込まれるように存在していた為, 後腹膜リンパ節郭清に加え左腎摘除術を併せて行った

A 29-year-old man was referred to our hospital with loss of appetite and a left lower abdominal mass. A small nodule was palpable in his left testis and ultrasonographic examination demonstrated that the nodule was low echoic. Computed tomography showed a large mass in his left retroperitoneal space. We thought the mass was a metastatic lesion from a testicular tumor. Left orchiectomy was done and microscopic examination revealed no viable tumor cells. Only fibrous tissue, small calcified areas, and hyaline bodies were found. As tumor markers were normalized after 3 courses of chemotherapy with bleomycin, etoposide, and cisplatine, the retroperitoneal mass was removed with the left kidney. It consisted of embryonal carcinoma, mature teratoma, and yolk sac tumor. One course of adjuvant chemotherapy was done and the patient has since been free from recurrence. We suppose that the tumor was a so-called 'burned-out' testicular tumor.