いわゆる"Endodermal Sinus Structure"を呈示した睾丸腫瘍の2例

Abstract

1. Two cases of embryonal carcinoma plus teratoma of testis exhibiting the endodermal sinus structures are presented. The first case, a man aged 27, was admitted to our hospital with chief complaint of a right painless testicular swelling of 18 months duration. At the time of first examination noticed was a thumb head-sized metastasis in the right lung. Orchiectomy was performed with postoperative tele-CO60 irradiation to the right lung and right retroperitoneal areas. The gross specimen consisted of a testis with attached epididymis measured 11×8×10 cm. On section the testis and epididymis appeared to be totally replaced by uneven tumor tissue which was pale grayish in color with some scattered focal hemorrhagic areas (Fig.1). The microscopic findings are illustrated in Figs.2~4. This patient died 13 months after operation due to enlarged lung metastasis and metastases of lymphnodes and skin. The second case, a 39-year-old man with the left painless testicular enlargement of 3 months duration, underwent left orchiectomy, left retroperitoneal lymphnode dissection, postoperative tele-CO60 irradiation to the retroperitoneal node-bearing areas, and chemotherapy with 5FU. The gross specimen measured 6.0×6.0×3.5 cm, 85g. On cut section the tumor-tissue consisted of uneven mass, which in some places was pale reddish and in others pale yellowish in color. In the most peripheral portion of this tumor showed an irregularly wide, bluish black zone of a few millimeters in width, surrounding almost all over the circumference of this tumor tissue, which was thought a hemangioma-like tissue or a hemorrhagic tumor tissue. Outside of this bluish black zone, the remnant of the narrow normal testicular tissue was seen on the left side of this tumor (Figs. 5, 6). The histological findings are illustrated in Figs.7~12. This patient is alive without any demonstrable evidence of recurrence or metastasis three years and 9 months after above-mentioned operations and treatments. 2. The microscopic examination could reveal that above-mentioned bluish black zone of the peripheral tumor tissue in the second case presumably might be the imitated reproduction of the complicated fetal portion of the labyrinthine placenta (Figs.9~11). 3. Literatures up to date were reviewed and some considerations were suggested.