異時性両側精巣原発悪性リンパ腫の1例

Abstract

62歳男.右陰嚢の無痛性腫大を自覚し, 超音波検査で右精巣に充実性の腫瘍を認めたため緊急入院した.画像所見などから右精巣腫瘍を疑い, 右高位精巣摘除術を施行した.病理組織学的検査で, non-Hodgikin's lymphoma, diffuse large cell typeと診断した.又, 精索浸潤を認めた.免疫学的検査はL26(CD20)陽性, UCHL1陰性でありB cell由来であった.術後, 可溶性インターロイキン2レセプター値の測定, 頸部CT, Gaシンチ, 骨シンチ, 骨髄穿刺を行ったが異常所見は見られなかった.cyclophosphamide, adriamycin, vincristineによる全身化学療法を3コース施行した.下大静脈腹側の腫大リンパ節が消失したことを確認し, 退院した.その後外来で経過観察していたが, 左陰嚢の無痛性腫大を自覚したため再入院し左精巣への再発を疑い左高位精巣摘除術を施行した.右精巣リンパ腫の対側精巣への再発と診断した.1年3ヵ月経過した現在更なる再発, 転移は見られていない

We report a case of metachronous malignant lymphoma of the bilateral testes. A 62-year-old man presented with a mass in the right scrotal contents. Physical examination revealed a solid painless mass in the right scrotal contents measuring 4 cm in diameter. He underwent right high orchiectomy. The histological examination confirmed non-Hodgkin's lymphoma of diffuse, large-sized cells of the B cell type. Computed tomography of the abdomen revealed paracaval lymphandenopathy at stage IIE according to Ann Arbor classification. Chemotherapy was initiated with cyclophosphamide, adriamycin and vincristine. Eleven months after the initial operation, the patient complained of left scrotal swelling, and subsequently underwent left high orchiectomy. The histological examination revealed the same pathology as observed in the right one scrotal contents. He was free from recurrence at 15 months after the second operation.