睾丸混合性非精原细胞性生殖细胞癌1例并文献复习

Testicular mixed nonseminomatous germ cell cancer:A case report and review of the literature

目的:睾丸混合性非精原细胞性生殖细胞癌的文献报道极少,本文旨在探讨睾丸混合性非精原细胞性生殖细胞癌的临床症状、病理特点及诊疗方法。方法:分析1例睾丸混合性非精原细胞性生殖细胞癌的临床资料,并运用组织学、细胞化学和免疫组化技术对该例睾丸混合性非精原细胞性生殖细胞癌进行光镜观察和免疫标记并结合文献就该类肿瘤的临床特征进行探讨。结果:患者以睾丸无痛性肿大3年就诊,病理组织学表现为肿瘤排列结构多样,有乳头状结构、裂隙或腺样结构,细胞大,呈多角形或柱状,核不规则呈泡状,一个或多个核仁,核膜清楚,胞质嗜碱或嗜酸,间质少量淋巴细胞浸润。免疫组化显示:白细胞分化抗原(CD117)(-)、细胞角蛋白(CK8-18)(++)、CD30(++)、CK(+++)、波形纤维蛋白(Vimentin)(-)、胎盘型碱性磷酸酶(PLAP)(±)、抑癌基因产物(P53)(+)、甲胎蛋白(AFP)(+)和上皮膜抗原(EMA)(++)。病理诊断为睾丸畸胎胚胎癌,行手术根治术,按混合性非精原细胞性生殖细胞癌行术后辅助化疗。随访时间l年,健康生存。结论:睾丸混合性非精原细胞性生殖细胞癌是一种罕见的恶性肿瘤,多数临床症状不明显。诊断主要依靠体格检查、B超、CT、血清肿瘤标记物测定等,确诊需要病理学检查,手术切除是其首选的治疗方法。

Objective：Testicular mixed nonseminomatous germ cell cancer （TMNGCC） is rarely reported. This study aimed to explore the clinical symptoms,pathological characteristics and treatment methods of TMNGCC. Methods：We analyzed the clinical data of 1 case of TMNGCC,observed its pathological characteristics under the light microscope by histology,cytochemistry,immunohistochemistry and immune marking,and investigated the clinical features of such tumors by reviewing the relevant literature. Results：The patient presented with a chief complaint of painless testicular swelling for 3 years. Histopathological examinations revealed a tumor of papillary,fissural or adenoid structure,with large polygonal or columnar cells with one or more irregular vesicular nuclei,the nuclear membrane clear,the cytoplasm eosinophilic or basophilic,and the interstitium infiltrated by a few lymphocytes. Here are the immunohistochemical results：CD117-,CK8-18 ＋＋,CD30 ＋＋,CK ＋＋＋,vimentin-,PLAP ±,P53 ＋,AFP ＋ and EMA ＋＋. The tumor was pathologically diagnosed as teratogenic embryonic testicular cancer,and treated by radical surgery,followed by adjuvant chemotherapy according to the treatment of TMNGCC. One-year follow-up found the patient to be alive. Conclusion：TMNGCC is a rare malignant tumor,mostly with unobvious clinical symptoms. Its diagnosis primarily depends on physical examination,ultrasonography,CT,and measurement of serum tumor markers; its confirmation necessitates pathological examination,and its first-choice treatment is surgical resection.