精巣セミノーマ化学療法11年後に見つかった脾血管肉腫の1例

Abstract

32歳男.22歳時に治療された左精巣セミノーマが2年後に再発し, 全身化学療法により完全緩解を得ていた.11年後, 右下肢痛が出現し, 精巣腫瘍再発が疑われた.検査所見では貧血と血小板減少を認め, CT, MRI, 骨シンチでは巨大脾腫, 脊髄へ腫瘍浸潤と全身性骨病変を認めた.血小板減少改善と脾臓破裂回避目的で脾臓摘出術を施行し, 更に確定診断のため骨生検を施行した.病理組織診断は血管肉腫であった.下肢痛改善のため腰椎と胸椎に放射線照射を行ったが, 大量の鼻出血が続き, 入院9ヵ月に癌死した.本例は末梢血リンパ球に染色体異常を認めており, これが化学療法により引き起こされ, 2次癌として脾血管肉腫が発生したと推測した

A 32-year-old man who had previously undergone chemotherapy for testicular seminoma 11 years ago was admitted to our hospital with a pain in the right leg. Computed tomography (CT) and bone scintigraphy revealed splenomegaly and multiple bone disease. Laboratory examination showed thrombocytopenia. The pathologic diagnosis of the resected spleen and the biopsied rib was angiosarcoma. We found no reports of angiosarcoma following previous chemotherapy for testicular cancer. It is unclear whether the angiosarcoma is a secondary neoplasm induced by the chemotherapy or not. However, the patient had a chromosomal aberration of the peripheral lymphocytes. The chemotherapy might also have affected the chromosomal aberration presumably in endothelial progenitor cells causing the development of a secondary neoplasm. To our knowledge, this is the first case of angiosarcoma after chemotherapy for testicular seminoma.