Computed Tomographyによる睾丸腫瘍の後腹膜転移巣の診断 --ことに横隔膜脚下(retrocrural space)のリンパ節腫大について--

Abstract

睾丸腫瘍15症例(stage 2 1例, stage 3 14例)を対象にして, 腹部CTにて後腹膜腔をinfrahilar space suprahilar space, retrocrural spaceの3つのレベルに分けてそれぞれのリンパ節腫大の頻度と臨床像との関係をしらべ, ことにretrocrural spaceのリンパ節腫大の意味を検討した.1) 15症例中, 11例はinfrahilarリンパ節に, 7例はsuprahilarリンパ節に, 6例(40.0%)はretrocruralリンパ節にそれぞれ腫大を認めた.2) retrocruralあるいはsuprahilarリンパ節に腫大を認めた症例は必ずそれ以下のsuprahilarあるいはinfrahilarリンパ節にも腫大を認めた.3) retrocruralリンパ節腫大の症例では後腹膜腔にbulky tumorを形成し, 頸部リンパ節にも転移を認める頻度が高かった.4) retrocruralリンパ節腫大の有無はとくに予後を左右する因子にはなりえなかった.5)睾丸腫瘍のみならず他の尿路性器癌の後腹膜リンパ節転移を検討する際, retrocruralリンパ節は後腹膜リンパ節の「sentinel node」(見張り番)としての役割をはたすことが示唆された

We tried to divide anatomically the retroperitoneal space into three areas on computed tomography, infrahilar, suprahilar and retrocrural spaces, and investigated the relationship between frequency of lymph node swelling in each space and clinical picture in 15 patients with testicular cancer of stage II or III, particularly focusing on the lymph node swelling in the retrocrural space. Lymph node swelling was found in the infrahilar space in 11 cases (73.3%), in the suprahilar space in 7 cases (46.7%) and in the retrocrural space in 6 cases (40.0%). Retrocrural or suprahilar lymph node swelling was always accompanied by suprahilar or infrahilar lymph node swelling. Most of the patients with retrocrural lymph node swelling had bulky tumors in the infrahilar level and frequently cervical lymph node swelling. Retrocrural lymph node swelling did not necessarily affect the patient's prognosis. The retrocrural lymph node seems to be a sentinel node for retroperitoneal lymph node swelling not only in the case of testicular cancer but also in the cancer of urogenital malignancies.