高分化乳头样睾丸鞘膜间皮瘤伴对侧非典型间皮增生1例并文献复习

Well-differentiated papillary mesothelioma occurring in the tunica vaginalis of the testis with contralat- eral atypical mesothelial hyperplasia(1case report and literature review)

目的探讨高分化乳头样睾丸鞘膜间皮瘤伴对侧非典型间皮增生的临床表现、病理特征、治疗方法和预后情况。方法回顾分析1例高分化乳头样睾丸鞘膜间皮瘤伴对侧非典型间皮增生患者的临床资料。结果患者接受了左睾丸鞘膜切除术,术中见鞘膜腔内淡黄清亮积液约30ml,睾丸鞘膜腔囊壁见多个实性乳头状突起,单个肿瘤最大直径9mm。术后病理:组织学上,结节表现为明显的外生性,伴有复杂的乳头状改变;细胞学上,尽管没有表现出恶性间皮瘤的基质侵袭性,但可见由扁平上皮细胞连接的单个小管样结构延伸入睾丸鞘膜浅层下组织。免疫组化Calretinin(+)、细胞角蛋白(CK)(+)、Vimentin(++)、上皮膜抗原(EMA)(-)。患者拒绝进一步行睾丸和阴囊皮肤切除术。术后1个月行右侧睾丸鞘膜切除术,病理回报非典型间皮增生。结论根治性睾丸切除术加患侧阴囊皮肤切除是睾丸鞘膜恶性间皮瘤的推荐治疗方法,对双侧睾丸鞘膜发病的患者,建议行根治性睾丸切除术。本例患者未接受睾丸根治术和术后放化疗等辅助治疗,密切随访36个月患者未见肿瘤复发或转移,说明高分化乳头样睾丸鞘膜间皮瘤是否需要根治性切除治疗仍有待进一步临床观察。

[A Objective To investigate the clinical and pathological features, treatment and prognosis of well-differentiated papillary mesothelioma （WDPM） occurring in the tunica vaginalis of the testis with contralateral atypical mesothelial hyperplasia. Methods The clinical date of 1 case were retrospectively analyzed. Results An operation was performed to incise the tumor and tunica vaginalis of left testes under continuous epidural anesthesi. 30 ml hydrocele and multiple papillae of maximum diameter 2 mm adherent to the tunica vaginalis were found during operation. Pathological examination demonstrated that the tubercles were exophytic accompany papillary change. Immuno- histochemistry shows Calrmtinin （＋）, CK （ ＋）, Vimentin （ ＋＋ ）, EMA （ -）. Patient refused radical orchiectomy and recieved excision of tumor and tunica vaginalis of right testes one month after the first operation. Conclusions Radical orchiectomy plus ipsilateral scrotal skin excision was rec- ommended to malignant mesothelioma of the tunica vaginalis and WDPM of the tunica vaginalis testis patients with bilateral testicular hydrocele disease, but this case without radical surgery and postop- erative radiotherapy and chemotherapy had no recurrence or metastasis in long-term follow-up, indi- cating the point of that paratesticular WDPM must underwent radical orchiectomy is still debatable.