隐睾并发睾丸网腺癌1例报告并文献复习

Adenocarcinoma of the rete testis with undescended testis: A report of 1 case and review of literature

目的:探讨1例隐睾并发睾丸网腺癌的临床病理学特征及诊治要点。方法:收集1例隐睾并发睾丸网腺癌患者的临床及影像学、观察期病理学形态及免疫表型,并复习相关文献,探讨其病理诊断和诊治要点。结果:患者老年男性,因右侧腹股沟肿痛一周入院。查体右侧腹股沟区触及实性肿块,压痛、质地较硬,右侧阴囊空虚。CT显示右侧腹股沟睾丸样肿块合并积液、腹膜转移增厚、腹水形成。病理组织学检查显示有乳头状结构,伴有腺体和小管,基质富含胶原,以实性病变为主。肿瘤细胞呈中度核异型性和频繁的核分裂。显微镜下可见曲细精管、精原细胞减少,基底膜增厚。肿瘤细胞免疫组化CEA^+、CA199^+、HBME-1^-、EMA^+、Calectin^-、CK5/6^-。结论:睾丸网腺癌临床罕见,病因不明,临床表现无特异性,确诊易延误。基本治疗是根治性睾丸切除术辅以根治性腹膜后淋巴结清扫术,转移性睾丸网腺癌予以化疗,放疗效果不佳。

Objective：To investigate the pathological characteristics and therapy of adenocarcinoma of the rete testis with undescended testis.Methods：A case of the rete testis with undescended testis was collected and his clinical and imaging materials,pathological morphology and immunophenotype,as well as related literatures were examined and analyzed.Results：The patient was admitted to our hospital because of right groin swelling for 1 month.Physical examination demonstrated a painful,hard,solid nodule in his right inguinal region and empty right scrotal.CT revealed a undescended testis on the right groin with effusion,peritoneal metastasis with ascites formation.The patient underwent orchiectomy,and the pathologic examination revealed tubular,papillary,cribriform,and solid structures,with the solid area being dominant.Neoplastic cells showed moderate nuclear atypia and frequent mitotic figures.At the same time,microscopic examination showed the seminiferous tubules,the spermatogonial cells decreased,and basement membrane thickening.Significant immunohistochemical reactivities for CEA,CA199,EMA were seen,there was no reactivity for HBME-1,Calectin,or CK5/6 protein.Conclusion：Adenocarcinoma of the rete testis is a rare malignant tumor with poor prognosis and unknown etiology.The primary treatment is radical orchiectomy with retroperitoneal lymphadenectomy,metastatic adenocarcinoma of rete testis should be given chemotherapy,radiotherapy is of no significant effect.