精巣固定術後に発生した精巣腫瘍の1例

Abstract

36歳男.有痛生鼠径部腫瘤の受診後, 大腿ヘルニアの嵌頓を疑い手術目的で入院した際, 左陰嚢内容の腫大も認めた.LDHの軽度高値腫瘍マーカーは正常範囲内, β-HCGは軽度高値を示し, 左鼠径部にisodensityのmassを左陰嚢にはややhigh densityのmassを認め, 左精巣腫瘍の診断で左高位精巣摘除術を行うこととした.大腿ヘルニアの嵌頓も否定できず手術を開始し, 左鼠径部の腫瘤は鼠径間外側皮下に存在し, 腫瘤および周囲の脂肪組織を一塊で摘除し, 高位精巣摘除術を施行した.腫瘍は充実性腫瘍で一部necrosisを伴い, 間質にはリンパ球浸潤を認めseminomaの所見で, 鼠径部腫瘤は同リンパ節転移と診断された.転移所見はなく, pure seminoma pT1N2MOと診断し, 補助化学療法(BEP療法2コース)を施行し経過観察中である.術後11ヵ月現在, 再発徴候は認めていない

A 36-year-old male with history of left orchiopexy at age 11 received medical examination at the emergency department of our hospital with a left painful inguinal tumor as the chief complaint. A surgeon examined and suspected a femoral hernia. However, he noticed the patient having a tumor in the left scrotum as well, and referred the patient to our department. Alpha-fetoprotein was within the normal range, but beta-human chorionic gonadotropin and lactate dehydrogenase were slightly elevated. We diagnosed the case as a left testicular tumor and performed left high orchiectomy. On histopathological examination, the tumor was a seminoma and the left inguinal tumor was a lymph node metastasis (3 x 4 x 5 cm). After operation, the tumor markers became normal and radiographic examination showed no evidence of metastasis to the retroperitoneal lymph nodes and to other organs. Subsequently, the patient was given 2 courses of systemic chemotherapy (bleomycin, etoposide, cisplatin) as an adjuvant therapy. At present, eleven months after operation, he showed no evidence of recurrence. To the best of our knowledge, there are 47 reported cases of this disease including ours in Japan.