A case of organized scrotal hematocele with high serum CA19-9 level

Abstract

67歳男人間ドックにて, 高CA19-9血症を指摘され, 全身検索の結果, 左陰嚢内の小児頭大の無痛性腫瘤との関連を疑われた.15年前に左陰嚢水腫にて手術の既往があるがほどなく再腫大し放置していた.画像診断においては積極的に悪性腫瘍の存在を示唆するような所見はえられなかったが, 持続して高CA19-9血症を認めたため高位精巣摘出術に準じて左陰嚢内腫瘤摘除術を行った.摘出腫瘤は内容暗赤色液体の単房性嚢胞であり壁の一部に圧排された左精巣を認めた.病理組織診断結果は器質化血腫であり, 内容液の細胞診ともども悪性腫瘍細胞の存在は確認されなかった.又, 免疫組織化学的検索において標本中にCA19-9陽性細胞を発見されなかったが術後よりただちに血清中CA19-9レベルの低下を認め, 術2ヵ月後には正常範囲内に落ち着いた.以後, 腫瘤の再発や血清中CA19-9レベルの再上昇を認めていない

A 67 year-old male consulted our department for examination a painless left scrotal mass accompanied by a continuously high serum carbohydrate antigen 19-9 level (CA19-9, 563.2 IU/ml). The patient underwent radical orchiectomy oof the mass. The histopathological diagnosis was an organized hematocele, and left testicular tissue was found in the cyst wall. There was no evidence of malignancy in the cyst wall or cyst contents, and immunohistochemical analysis showed no CA19-9-positive cells. However, the CA19-9 level lowered to the normal range immediately after surgery. The patient's CA19-9 level has remained normal, with no recurrence of tumor to date. Considering the clinical course, we suspected the resected mass to have been the cause of the high serum CA19-9 level, and to our knowledge, this is the first case report of organized hematocele in the scrotum with a high CA19-9 level.