成人睾丸间质细胞瘤：单中心17例报告

Leydig cell tumor of the testis in adult： 17 cases report in a single institution

目的 探讨成人睾丸间质细胞瘤的临床病理特点,明确适宜的外科治疗方式.方法 回顾性分析北京大学第一医院1997年6月至2013年2月诊治的17例成年睾丸间质细胞瘤患者的临床资料,年龄21 ～ 77岁,平均37岁.肿瘤位于右侧7例,左侧9例,双侧1例.自行扪及或体检触诊发现睾丸肿大或肿物16例,其中2例伴患侧睾丸疼痛,l例因单侧隐睾及不育症就诊时超声检查发现隐睾内肿瘤.17例患者性征发育均正常.术前常规行肿瘤标志物AFP和β-HCG检查,8例术前行性激素水平检查.结果 17例患者术前AFP和β-HCG水平均正常.8例行性激素检查患者中3例出现雄激素或雌激素水平异常.16例单侧肿瘤患者行睾丸根治性切除术,1例双侧肿瘤患者行肿瘤剜除术.肿瘤平均直径2.2 cm（0.7～4.2 cm）,6例病理提示恶性征象.4例患者术后即刻行腹膜后淋巴结清扫术,其中2例发现腹膜后淋巴结转移.术后17例患者均获随访,平均随访30个月（2～82个月）.1例未即刻行腹膜后淋巴结清扫术的患者随访至术后11个月发现腹膜后淋巴结转移.本组共3例出现腹膜后淋巴结转移,其中2例分别随访至术后42个月和13个月时发现肺转移,后者随访至术后23个月死亡.其余患者未见复发或转移.结论 部分成人睾丸间质细胞瘤呈恶性病程,需严密随诊.病理有恶性征象或怀疑腹膜后淋巴结转移者需尽早行腹膜后淋巴结清扫术,转移患者预后较差.

Objective To investigate the clinical and pathological features of Leydig cell tumor of the testis in adult,and to identify the optimal surgical treatment.Methods The data of 17 Lydig cell tumor patients diagnosed from Jun.1997 to Feb.2013 was collected.We retrospectively analyzed the clinical and pathological features,treatment and survival.Results Serum αt-fetoprotein and β-human chorionic gonadotropin levels were normal in all patients.In 3 of 8 patients with hormonal profile data,the total testosterone or estradiol was abnormal.Sixteen patients underwent radical orchiectomy,while one patient underwent testis sparing surgery for bilateral Leydig cell tumors.Mean tumor diameter was 2.2 cm （range 0.7-4.2 cm）.Histopathological characteristics associated with malignant potential were seen in 6 patients.The mean follow-up time was 30 months.Four patients received retroperitoneal lymph node dissection and two of them were detected retroperitoneal lymph node metastasis.All of the 17 cases were followed up with the mean follow-up duration of 30 months （2-82 months）,and 1 of them were detected retroperitoneal metastasis at the 11 months later follow-up who did not undergo retroperitoneal lymph node dissection.Two of the three cases who had retroperitoneal metastasis finally developed lung metastasis at the follow-up 42 months or 13 months later and the earlier metastatic case died of metastasis 23 months after the surgery.The other cases had no recurrence or metastasis.Conclusions Adult Leydig cell tumor patients need intensive surveillance because of its potentially aggressive malignant behavior.Retroperitoneal lymph node dissection remains an option to be performed immediately after orchiectomy for Leydig cell tumor patients,especially in patients who have tumors with malignant features and/or localized retroperitoneal lymph node metastasis.The prognosis of leydig cell tumor patients with metastasis was poor.