悪性腫瘍との鑑別が困難であった精子肉芽腫症の1例

Abstract

33歳男.主訴は左陰嚢内無痛性腫瘤.超音波検査では精巣上体尾部に径2cm大の低エコー領域を認め, 精巣との境界は不明瞭であった.その部分から体部及び頭部にかけて一部高エコーを含む腫瘤が連続していた.精巣上体腫瘍を疑い手術を施行した.左鼠径部切開を行い, 陰嚢内容を脱転して観察すると腫瘤は精巣上体から精索へと連なる形で存在し, 長径約6cmで硬く不整であった.その大きさと性状より精巣上体或いは精索に由来する悪性腫瘍も否定できず高位精巣摘出術を行った.腫瘤部分と精巣上体内は精子と思われる細胞を取り囲む形で形成された肉芽腫で満たされていたが, 精巣組織には異常なかった.以上より精子肉芽腫症と診断された

A 33-year-old man visited our hospital with complaint of painless left intrascrotal mass. A hard and rough induration in contact with the left testis was palpable. The laboratory data including beta-human churionic gonadotropin, alpha fetoprotein and lactate dehydrogenase were normal. Ultrasound sonography showed a large hypoechoic lesion at the left epididymis. Surgical exploration of this lesion indicated a malignant tumor of the epididymis or spermatic cord, and left high orchiectomy was performed. A milk-white nodule 6 cm in diameter was found in the resected specimen. Pathological diagnosis was spermatic granuloma. Fourteen cases of spermatic granuloma have been reported in the last twenty years in Japan. All of them were relatively small nodules and epididymectomy was performed for most of them. We selected radical orchiectomy because of a large nodule with suspicion of malignant lesion.