睾丸鞘膜恶性间皮瘤1例报告

Malignant mesothelioma of the tunica vaginalis testis： one case report

目的探讨睾丸鞘膜恶性间皮瘤的临床特征及诊治方法。方法报告1例睾丸鞘膜恶性间皮瘤患者的临床资料。男性，73岁，临床表现右侧阴囊进行性增大1年，B超睾丸周围可见约7．5cm×4．1cm液性暗区。检索Pubmed和CBM数据库相关文献进行学习。结果患者行右侧睾丸鞘膜切除术，术后病理：睾丸鞘膜间皮细胞增生，伴非典型性增生，局灶恶变，免疫组化：CK5／6（＋），Calretinin（＋），E-cadlherin（＋）。3周后行右睾丸切除，术后11个月患者出现右侧阴囊肿物及腹股沟淋巴结肿大，行右侧阴囊肿物切除及腹股沟淋巴结切除，术后病理：脂肪结缔组织及纤维组织中恶性间皮瘤浸润，免疫组化：CK5／6（＋），Calretinin灶状（＋）。结论睾丸鞘膜恶性间皮瘤临床罕见，生物学行为进展快，临床症状不典型，缺少特异性肿瘤标记物，术前诊断较难，诊断主要依据病理，治疗以根治性手术为主，术后需长期严密随访，患者预后差。

Objective To study the clinical and pathological features, diagnosis and treatment of malignant mesothelioma of the tunica vaginalis testis. Methods One case of malignant mesothelioma of the tunica vaginalis testis was reported. The patient was a 73 years old man, presented with a history of aggravated hydrocele for 1 year. B-ultrasound showed 7.5 cm × 4. 1 cm liquid anechoic area around the testis. The Pubmed and CBM databases were searched for related articles, and the clinical data were reviewed. Results An operation was performed to incise the tunica vaginalis. The pathology showed focal canceration in the tunica vaginalis testis and the immunohistology showed CK5/6, Calretinin and E-cadlherin positive. Right orchiectomy was performed after three weeks. Local tumor recurrence and inguinal lymph nodes metastasis were found 11 months after operation, and local tumor and lymph nodes were resected. The tumor was diagnosed as malignant mesothelioma of the tunica vaginalis testis and CK5/6 and Calretinin focal positive. Conclusions Malignant mesothelioma of the tunica vaginalis is a rare disease of the testis with potentially aggressive behavior. Due to the lack of tumor markers and characteristic symptoms, correct preoperative diagnosis is extremely difficult. Radical surgical treatment is of major importance to the survival of the patients. Lifelong follow-up should be offered to patients with malignant mesothelioma of the tunica vaginalis.