精巣原発悪性リンパ腫の1例

Abstract

54歳男.右陰嚢内容の無痛性腫大を主訴とした.超音波で右精巣尾部から体部にかけて境界明瞭で均一な低エコー領域を認め, 僅かに正常組織が頭部方向に圧排されるように残存していた.カラードプラ法では腫瘤内の血流の増加が認められた.MRIでは腫瘍はT1強調像で正常精巣とほぼ等信号を, T2強調像では正常精巣よりも低信号を示し, ガドリニウムで造影効果を示した.右精巣腫瘍と診断し, 右高位精巣摘除術を施行した.病理組織学的所見では, HE染色で大型の類円形核と好酸性の乏しい細胞質を有する異型細胞のび漫性増殖を認めた.免疫組織学的には腫瘍細胞はCD20に陽性を示し, 本腫瘍はWorking Formulation分類におけるnon-Hodgkin's lymphoma, diffuse large cell type, B-cell typeと診断した.術後の画像検査では異常所見は認められなかった.Ann Arbor分類によりstage I eAの診断でCHOP療法を4コース施行し, 退院後は外来で維持療法としてCOP療法を施行中である

We report a case of malignant lymphoma arising from the testicle in a patient who had been on chemotherapy for a long period after orchiectomy. A 54-year-old male presented with indolent swelling in the right scrotum. Diagnosed as having a testicular tumor by ultrasonography and MRI, he underwent orchiectomy. According to the histopathological diagnosis, the tumor was classified as non-Hodgkin's lymphoma, diffuse large cell type, B cell type. Diagnosis of Stage I eA was made by the Arr Arbor classification. Four courses of cycrophosphamide, adriamycin, vincristin and prednisolone (CHOP) therapy were administered. COP (CHOP minus adriamycin) therapy has been given every four months on an out-patient basis. At present, 28 months after the operation, no evident recurrence has been found.