Fernández Gómez Jesús María, Guate Ortiz José Luis, Martín Huescar Agustín, Fresno Forcelledo Florentino, Escaf Barmadah Safwan, García Rodríguez Javier, Pérez García Francisco Javier, Rodríguez Faba Oscar, Jalón Monzón Antonio
Servicio de Urología I, Hospital Covadonga, Hospital Central de Asturias, Facultad de Medicina, Universidad de Oviedo, Oviedo, España.
Arch Esp Urol. 2002 Oct;55(8):915-22.
To review the clinical features in our series of patients of germ-cell testicular cancer.
The charts of 73 patients with diagnosis of germ-cell testicular tumours were reviewed. Age, history of cryptorchism, time to diagnosis, main symptoms, and serum markers values (alpha- fetoprotein and beta-HCG) were analysed. All cases underwent orchiectomy and extension study with abdominal CT-scan and either chest X-ray or Thoracic CT-scan. We follow the AJCC-UICC 1997 stage classification. Histological cell line, size, and clinical stage at presentation (local, regional and distance) have been analysed also.
Among 73 germ-cell testicular tumours 34 were seminomas (46.6%) and 39 were non-seminomatous (54.4%). Clinically, 58.9% of the patients had localised stage I tumours. On presentation 85.7% seminomas were stage I compared to 35.9% non-seminomatous tumours. The remaining tumours were diagnosed in advanced phases (stages II and III). Inguinal orchiectomy was performed in all patients except 5 in whom tumours were incidentally diagnosed (atrophic testis orchiectomy, hydrocoelectomy, trauma) and needed a second operation including ipsilateral scrotal excision. When size, cell line and primary tumour T category were reviewed we found that 32.3% seminomas and 20.5% non seminomas were smaller than 4 cm. 50% seminomas and 49.7% non seminomas were pT1; 41.2% seminomas and 28.2 non seminomas were pT2; finally 8.8% seminomas were pT3 compared to 23.1% non seminomas. Vascular infiltration, also evaluated in this chapter, was present in 38.2% seminomas compared to 38.5% non seminomas. Elements of embryonal carcinoma were found in 37 non seminomatous tumours, either isolated (14) or associated with other components. Teratoma appeared in 18 non seminomatous tumours, 16 of them associated to embryonal carcinoma alone or together with other components. Elements of choriocarcinoma and endodermal sinus were evident in 5 and 4 cases respectively, always associated with other elements.
Seminomas clinical presentation substantially differs from that of non seminomatous testicular tumours in age, clinical features, stage and histological aggressiveness.
回顾我们系列睾丸生殖细胞癌患者的临床特征。
回顾了73例诊断为睾丸生殖细胞肿瘤患者的病历。分析了年龄、隐睾病史、诊断时间、主要症状以及血清标志物值（甲胎蛋白和β-人绒毛膜促性腺激素）。所有病例均接受了睾丸切除术，并通过腹部CT扫描以及胸部X线或胸部CT扫描进行扩展检查。我们采用AJCC-UICC 1997年分期分类。还分析了组织学细胞系、大小以及就诊时的临床分期（局部、区域和远处）。
在73例睾丸生殖细胞肿瘤中，34例为精原细胞瘤（46.6%），39例为非精原细胞瘤（54.4%）。临床上，58.9%的患者为局限性I期肿瘤。就诊时，85.7%的精原细胞瘤为I期，而非精原细胞瘤为35.9%。其余肿瘤诊断为晚期（II期和III期）。除5例肿瘤为偶然诊断（萎缩性睾丸切除术、鞘膜积液切除术、外伤）且需要包括同侧阴囊切除在内的二次手术的患者外，所有患者均进行了腹股沟睾丸切除术。当回顾大小、细胞系和原发肿瘤T类别时，我们发现32.3%的精原细胞瘤和20.5%的非精原细胞瘤小于4 cm。50%的精原细胞瘤和49.7%的非精原细胞瘤为pT1；41.2%的精原细胞瘤和28.2%的非精原细胞瘤为pT2；最后，8.8%的精原细胞瘤为pT3，而非精原细胞瘤为23.1%。本章中也评估了血管浸润情况，38.2%的精原细胞瘤和38.5%的非精原细胞瘤存在血管浸润。在37例非精原细胞瘤中发现了胚胎癌成分，要么单独存在（14例），要么与其他成分相关。畸胎瘤出现在18例非精原细胞瘤中，其中16例仅与胚胎癌相关或与其他成分一起存在。绒毛膜癌和内胚窦成分分别在5例和4例中明显，且总是与其他成分相关。
精原细胞瘤的临床表现与非精原细胞瘤在年龄、临床特征、分期和组织学侵袭性方面存在显著差异。
