日本病理剖検輯報よりみた睾丸腫瘍の実態

Abstract

昭和42年から51年までの10年間に日本病理剖検輯報に収録された睾丸悪性新生物1437例について検討を加えた.胚細胞性睾丸癌は417例, 続発性腫瘍は1027例でその比は1:2.46であった.続発性腫瘍966例の原疾患は白血病541例(56%), 癌腫188例(19.4%), リンパ系肉腫184例(19.0%)であった.胚細胞性睾丸癌410例の組織学的分類(Dixon & Moore)では2型, 1型が多く, 組織型ではembryonal carcinoma, seminomaが多かった.転移パターンの分析には組織型の明らかな369例を用い, リンパ節転移のパターンは5群間に有意差はなかったが, seminomaとembryonal carcinomaの間には僅かの差が見られた.遠隔転移のパターンは5群間および, seminomaとembryonal carcinomaなどの間に有意差が見られた.剖検時の所見がすぐ予後と結びつくかは疑問としても, 剖検時の転移パターンからは成人の胚細胞性睾丸腫瘍はseminoma, choriocarcinoma, embryonal carcinoma+teratocarcinoma+teratomaの3群に分類しうる

A review was made on 1, 437 cases of testicular malignancies reported in the Annual of the Pathological Autopsy Cases in Japan between 1967 and 1976. They were 417 cases of germinal testicular cancer and 1, 027 cases of secondary tumors, the ratio between the two being 1:2.46. The primary disease of 966 cases of secondary tumors was known: It was leukemia in 541 cases (56%), cancer in 188 cases (19.4%) and lymphosarcoma in 184 cases (19.0%), in decreasing order of frequency. The histological classification of the 410 germinal cell carcinoma given clear description was type I, II, III, IV and V according to Dixon and Moore's classification in 34.4%, 38.5%, 3.7%, 10.2% and 13.2%, respectively. There were 369 cases consisting of only one histological type, which was seminoma, embryonal carcinoma, teratoma, teratocarcinoma and choriocarcinoma in 38.2%, 39.0%, 3.8% 10.0% and 9.0% of these cases, respectively. The pattern of metastasis was analyzed for these 369 cases. There was no significant difference in the pattern of lymph node metastasis between the 5 groups, but there was a slight difference between seminoma and embryonal carcinoma. There was a significant difference in the pattern of distant metastasis between the 5 groups and between choriocarcinoma and seminoma, choriocarcinoma and embryonal carcinoma, and, choriocarcinoma and teratocarcinoma. It is questionable whether the findings at autopsy directly relate to prognosis, but considering from the pattern of metastasis at autopsy, the adult germinal cell testicular tumors can be divided into the three groups: seminoma, choriocarcinoma and embryonal carcinoma + teratocarcinoma + teratoma.