成人睾丸内胚窦瘤诊治经验

Adult endodermal sinus tumor of testis：report of 6 cases

目的总结成人睾丸内胚窦瘤的诊治经验。方法成人睾丸内胚窦瘤患者6例。年龄18～37岁，平均28岁。主诉患侧睾丸肿大5例，患侧隐睾部位疼痛1例。查体患侧睾丸均明显增大，伴腹部肿物及腹腔积液2例。B超及CT检查均提示腹膜后淋巴结转移。UICC分期：Ⅰ期2例、Ⅱ期3例、Ⅲ期1例。6例均行患侧根治性睾丸切除术，其中1例行腹膜后淋巴结清扫术（RPLND）。术后6例均行化疗。5例行硫酸长春碱加顺铂加博来霉素或顺铂加依托泊苷加博来霉索方案；1例行RPLND者联合腹膜后、盆腔区域高能X线放疗，总剂量30Gy，5周内完成。1例行N-甲酰溶肉瘤索加顺铂方案化疗。结果6例术后病理诊断均为睾丸内胚窦瘤。肿瘤切面呈实质性，质地脆软，色灰白或浅黄，呈海绵状；镜下见血管周围肿瘤细胞呈放射样排列，外围肿瘤细胞呈圈状，与原始的肾小球极为相似，细胞核有异型性，可见核分裂象。瘤细胞胞质互相联合成网状、腺泡状、管状，相互沟通吻合如迷路。1例术后2个月失访。5例随访1．5～8．0年。每3个月复查胸部X线片及B超，每6个月复查腹部CT或MRI扫描，未见局部复发及远处转移。结论成人睾丸内胚窦瘤临床罕见，确诊主要依靠病理学检查，根治性睾丸切除术加术后放化疗能明显提高治愈率。

Objective To discuss the diagnosis and outcome of adult endodermal sinus tumor of testis. Methods The clinic data of 6 cases of adult endodermal sinus tumor of testis were reviewed. The patients＇ average age was 28 years. Five patients complained of an asymptomatic scrotal mass and 1 patient complained of the pain of eryptorchidism. All patients received radical orchiectomy as initial treatment. Pathology results suggested 2 patients with stage Ⅰdisease, 3 patients with stage Ⅱ disease and 1 patient with stage Ⅲ disease. All were treated with chemotherapy or radiotherapy following radical orchieetomy. Retroperitoneal lymph node dissection（RPLND）was performed in 1 case with stage Ⅱ disease. Results Six cases of adult endodermal sinus tumor of testis were confirmed by pathology. Five patients were followed up for 1.5 year to 8 years, no local recurrence and distant metastasis were found. Conclusions Adult endodermal sinus tumor is a rare neoplasm of the germinal cell line. Pathological examination is the key to diagnosis. Postoperative combination chemotherapy and radiotherapy are the most common means of this disease.