成人睾丸腫瘍の臨床的検討 第2部: hCG陽性例について

Abstract

成人睾丸精細胞性腫瘍患者110例中19例にhCG陽性例を認め, 臨床的検討をおこなった.1)セミノーマ65例中2例, 非セミノーマ45例中17例がhCG陽性であった.2) hCG陽性19例のうち絨毛癌を確認できたものは10例, 確認できなかったものは9例であった.3) hCG陽性例において原発巣と転移巣の組織型を比較したところ, 不一致例が多く睾丸腫瘍の組織診断のむつかしさを示した.4)血中hCG濃度と絨毛癌の有無については, 絨毛癌の証明されたものでは3, 000 mIU/ml以上と高値を示し, 絨毛癌の証明されなかったものは1, 000 mIU/ml以下と低値であった.5) hCG陽性例は絨毛癌組織の有無にかかわらず陰性例に比べ進行例が多いために予後が悪かった.6) hCG陽性例でも予後はstageに関係し, stage 1の予後はよく2, 3で悪い傾向がうかがえた

The outcome of clinical therapy of testis tumor presenting with positive human chorionic gonadotropin (hCG) in our hospital is reported. Of 110 patients with adult germ cell testis tumor, 19 (17.3%) had elevated hCG levels in serum or urine. Two (3.1%) of the 65 patients with seminoma and 17 (37.8%) of the 45 non-seminoma patients had positive hCG. Chorionic elements were confirmed at primary and/or metastatic sites in 10 (52.6%) of these patients, and in not a few cases different histologic features were seen at the two sites. Many patients with chorionic elements had high hCG levels (more than 3, 000 mIU/ml) in serum, while patients in whom no chorionic elements were detected had low hCG levels (below 1, 000 mIU/ml). The hCG-positive group seemed to have a poor prognosis because they were mostly in an advanced stage at their first visit to the hospital, and no difference in prognosis was found between the patients with chorionic elements and those without. The advanced group had a poor prognosis irrespective of their hCG levels.