睾丸恶性间质细胞瘤1例报告

Testicular malignant Leydig cell tumor: A case report

目的:提高对睾丸恶性间质细胞瘤(TMLCT)临床病理特征的认识及无创诊断水平。方法:回顾性分析1例患者(年龄47岁)TMLCT的临床病理资料,检测患者外周血循环肿瘤细胞(CTC)并进行文献复习。结果:全麻下行根治性右睾丸肿瘤切除术。术后病理示:TMLCT,以间质细胞为主,可疑脉管癌栓。免疫组化染色示:α-抑制素(+),波形蛋白部分(+),EMA(+),PLAP(+),CD30(+),Ki67约5%(+),CK(-),CK7(-),S100(-),CD10(-),SMA(-),Des(-),AFP(-),h CG(-),CEA(-),CK19(-),CD117(-),Oct-4(-),LCA(-),CD20(-),Pax-5(-),CD3(-),CD43(-)。患者外周血中共检测到2个CTCs。术后复查因多发淋巴结转移行化疗3个疗程,随后复查CT见腹膜后淋巴结转移无明显缩小,予行腹膜后肿物切除+冷冻消融术。随访8个月复查CT见腹膜后转移淋巴结较前增大并肾上腺转移。结论:TMLCT是极罕见的性索间质肿瘤,恶性度高,预后差,而CTC有望用于其早期诊断及预后预测。

Objective： To investigate the clinicopathological features of testicular malignant Leydig cell tumor（ TMLCT） and improve the non-invasive diagnosis of the disease. Methods： We retrospectively analyzed the clinicopathological data on a case of TMLCT,detected the circulating tumor cells（ CTC） in the peripheral venous blood,and reviewed the related literature. Results：The patient,a 47-year-old male,underwent radical orchidoepididymectomy under general anesthesia. Postoperative pathology confirmed the lesion to be TMLCT,which was mainly composed of Leydig cells and suspected with vessel carcinoma embolus. Immunohistochemistry showed the tumor cells to be positive for α-inhibin,Ki67,CD30,vimentin,EMA,and PLAP,but negative for CK,CK7,S100,CD10,SMA,Des,AFP,h CG,CEA,CK19,CD117,Oct-4,LCA,CD20,Pax-5,CD3,and CD43. Two CTCs were detected in the peripheral venous blood. The patient received 3 courses of chemotherapy for retroperitoneal multiple lymph nodes metastasis postoperatively. Subsequent CT imaging manifested no obvious reduction of the retroperitoneal lymph nodes and consequently the patient again underwent retroperitoneal lymphadenectomy and cryoablation. At 8 months after treatment,CT examination revealed notably enlarged retroperitoneal lymph nodes with the right adrenal gland evidently invaded. Conclusion： TMLCT is an extremely rare sex-gonad stromal tumor with high malignancy and poor prognosis,and CTCs may be used for its early diagnosis and prognostic prediction.