睾丸间质细胞瘤16例诊断治疗分析

Diagnosis and treatment of 16 patients with leydig cell tumors

目的 分析睾丸间质细胞瘤的临床特点,以提高睾丸间质细胞瘤的诊断及治疗水平.方法 回顾性分析郑州大学第一附属医院2013年3月至2018年7月诊治的16例睾丸间质细胞瘤患者的临床资料,患者年龄3~62岁,平均28.7岁.肿瘤位于左侧6例,右侧8例,双侧2例.10例行睾丸根治性切除术(其中1例行双侧睾丸肿瘤切除术),5例行保留睾丸的肿瘤剜除术,1例双侧睾丸肿瘤患者行左侧保留睾丸的睾丸剜除术.结果 16例患者的肿瘤平均直径为2.3(0.7~4.0)cm.所有患者术后病理回示均为睾丸间质细胞瘤,其中1例病理提示为恶性,因CT未发现转移,术后未进一步治疗,且随访67个月未见转移.1例术前CT提示双侧肾上腺转移患者行2个周期PEB(依托泊苷+顺铂+博来霉素)方案化疗,术后随访60个月,未见新发转移.所有患者术后平均随访30(3~67)个月,均未见复发或转移.结论 睾丸间质细胞瘤是临床上比较罕见的肿瘤,临床诊断较为困难,确诊依赖于组织病理.治疗以手术为主,单侧肿瘤且无生育要求或肿瘤体积相对于睾丸体积较大者可选择睾丸根治切除术,而对于青春期前患者、双侧睾丸间质细胞瘤等患者,特别是病理检查确诊是良性睾丸间质细胞瘤患者,保留睾丸的肿瘤剜除术应为首选.

Objective To analyze the clinical features of leydig cell tumors and to improve the diagnosis and treatment of the disease.Methods The clinical data from 16 patients with leydig cell tumors treated in the First Affiliated Hospital of Zhengzhou University from March 2013 to July 2018 were retrospectively analyzed.Their age ranged from 3 to 62 years,with an average of 28.7 years.The tumor was located on the left side in 6 cases,located on the right side in 8 cases,and located on the bilateral sides in 2 cases.Ten patients underwent radical resection of the testicles(1 of them underwent bilateral resection of testicular tumor),and 5 patients underwent tumor enucleation with testicular preservation,and 1 patient with bilateral testicular tumors underwent tumor dissection with left testicular reserved.Results The average tumor diameter of the 16 patients was 2.3 cm(0.7 to 4.0 cm).Postoperative pathological findings of all the patients were leydig cells.And 1 of them was malignant,without metastasis according to computed tomography(CT),so no further treatment after operation were performed on the patient;and no metastasis was found in the patient during 67-month follow-up.One patient with preoperative CT showing bilateral adrenal metastasis was treated by 2 cycles of etoposide,cisplatin and bleomycin regimen;the patient was followed up for 60 months,without any metastasis.All patients were followed up for 3 to 67 months,with an average of 30 months,and no recurrence or metastasis was found.Conclusions Leydig cell tumor is a kind of rare tumor in clinical practice.It is difficult to diagnose the disease in clinical.The definite diagnosis depends on histopathology.Surgery is the main treatment method.For patients with unilateral tumors and no fertility requirements or with large tumor volume compared to testicular,radical resection of the testicular is appropriate;while for prepubertal patients or patients with bilateral sputum stromal tumors,especially,the patients with benign leydig cell tumors confirmed by pathological examination,tumor enucleation with preserving testicular is appropriate.