精索平滑肌肉瘤1例报告并文献复习

Leiomyosarcoma of the spermatic cord:one case report and literature review

目的：探讨精索平滑肌肉瘤的影像、病理特征及治疗方法。方法回顾性分析2014年11月收治1例精索平滑肌肉瘤患者的诊治情况。男性患者，46岁，因无痛性阴囊左侧肿物13年入院。查体：阴囊左侧可触及一质地坚实、大小约5.0cm×4.0cm的肿物，透光试验阴性。B超检查提示左侧精索上附有一内部不均质的肿物，而且肿物并不与左侧睾丸及附睾粘连。左侧精索增粗，血供丰富。甲胎蛋白1.00ng/mL，人绒毛膜促性腺激素＜1.2mIU/ml，心电图和胸部X线片均正常。术前诊断为左侧精索肿瘤。结果行阴囊切口手术摘除肿瘤，术中见肿瘤切面灰红结节状，冰冻切片提示精索梭形细胞肿瘤，待免疫组化明确病变性质。术后病理HE染色瘤细胞呈长梭形，束状排列。细胞核呈杆状，异型性较大，核大深染，可见核分裂象，免疫组化显示Desmin、SMA、Vimentin阳性，Ki-67（40%），而EMA，CD68为阴性。诊断符合精索平滑肌肉瘤，遂二期行经腹股沟切口根治性睾丸切除术。术后行局部放射治疗。术后1年未见肿瘤复发。结论精索平滑肌肉瘤是一种罕见的男性泌尿生殖系统肿瘤，临床表现缺乏特异性。诊断该病主要依据病理HE染色及免疫组化标志物，并且需与其他梭形细胞肿瘤鉴别，根治性睾丸切除术后辅助放射治疗是一种有效的治疗方法。

Objective To discuss the imageological, pathological features, and treatments of leiomyosarcoma of the spermatic cord.Methods A case of the leiomyosarcoma of the spermatic cord was reported in November 2014. A 46 -year-old male patient presented with a 13 years history of painless lump in the left hemiscrotum. Physical examination revealed that a firm-to-hard lump with the size of 5.0cm×4.0cm on the left hemiscrotum, and the transillumination test was negative. B-ultrasound examination demonstrated a solid lump of uniform homogeneity that attached to the left spermatic cord. And the lump separated from the left testis and epididymis, with the left spermatic cord augmented and rich blood supply. The serum alpha-fetoprotein was 1.00ng/mL, serum human chorionic gonadotropin and chest X-ray were both normal. The preoperative diagnosis was the tumor of left spermatic cord.Results The patient underwent operation after scrotum incision under general anaesthesia. During operation the tumor section with grey-red nodular can be seen,and the frozen section indicated spindle cell type tumor, to know the tumor was benign or malignant after identifying immunohistochemical lesion characters. Postoperation histopathology HE staining indicated that the tumor cells showed long fusiform,and arranged in fascicles.The cell nucleus with atypia was rod-shaped and hyperchromatic,after then mitotic could be seen more. Immunohistochemical examination revealed positive for Desmin,SMA and Vimentin, Ki-67（40%）, negative for EMA and CD68. The results accorded with the leiomyosarcoma of spermatic cord,so two-stage radical orchidectomy for this patient after inguinal incision. Then continue to the local radiotherapy. During the follow-up period for one year, no recurrence occurred.Conclusion The leiomyosarcoma of the spermatic cord is a very rare malignant tumor in the male reproductive system tumor, and this kind of disease has no special feature in clinical manifestation.The diagnosis mainly depends on histopathology HE staining and special marks in immunohistochemistry, the differentces of this disease and spindle cell type tumor should be identified. The radical orchidectomy and the postoperation local radiotherapy is a kind of effective therapeutic method.