Wang Lan, Pitman Martha B, Castillo Carlos Fernandez-Del, Dal Cin Paula, Oliva Esther
Department of Pathology, Harvard Medical School, Boston, MA 02114, USA.
Mod Pathol. 2004 Dec;17(12):1573-80. doi: 10.1038/modpathol.3800226.
We describe an unusual case of metastatic choriocarcinoma of the pancreas arising from a regressing testicular mixed germ cell tumor that clinically mimicked a primary pancreatic tumor. A 54-year-old male presented with a 2-month history of progressive upper abdominal pain, weight loss, and jaundice. He also had a history of recurrent epididymitis associated with the presence of a right testicular mass shown to be cystic by ultrasound and stable for at least 10 years. A computed tomography scan showed an isolated 6 cm mass in the head of the pancreas. A pancreaticoduodenectomy was performed. Upon histological examination, the pancreatic tumor showed extensive hemorrhage and necrosis. In the viable area, the tumor was composed of an intimate mixture of mononuclear cytotrophoblast cells and multinucleated syncytiotrophoblasts with vascular invasion. These characteristic features led to the correct diagnosis on frozen section. The cytology of the tumor was nonspecific and suggested undifferentiated carcinoma of the pancreas. The trophoblastic origin of the tumor cells was confirmed by immunohistochemistry staining. The testicular mass showed a regressed mixed germ cell tumor of predominantly seminoma with focal teratoma but without a choriocarcinoma component. In conclusion, we present a rare and unusual case of a regressing testicular mixed germ cell tumor that presented as a primary pancreatic tumor. Cytological features of the pancreatic mass were not specific and raised the possibility of a primary undifferentiated carcinoma of the pancreas. Characteristic histological features of choriocarcinoma led to the correct diagnosis on frozen section. Subsequent resection of the testicular mass confirmed the presence of a cystic and scarring (regressing) mixed germ cell tumor but without evidence of choriocarcinoma.
我们描述了一例罕见的胰腺转移性绒毛膜癌病例，其起源于消退性睾丸混合生殖细胞肿瘤，临床上酷似原发性胰腺肿瘤。一名54岁男性，有2个月进行性上腹部疼痛、体重减轻和黄疸病史。他还有复发性附睾炎病史，伴有右侧睾丸肿块，超声显示为囊性，至少稳定10年。计算机断层扫描显示胰腺头部有一个孤立的6厘米肿块。进行了胰十二指肠切除术。组织学检查显示，胰腺肿瘤有广泛出血和坏死。在存活区域，肿瘤由单核细胞滋养层细胞和多核合体滋养层细胞紧密混合组成，并伴有血管侵犯。这些特征性表现使得在冰冻切片时做出了正确诊断。肿瘤的细胞学表现不具特异性，提示为胰腺未分化癌。肿瘤细胞的滋养层起源通过免疫组化染色得以证实。睾丸肿块显示为主要为精原细胞瘤伴局灶性畸胎瘤的消退性混合生殖细胞肿瘤，但无绒毛膜癌成分。总之，我们报告了一例罕见且不寻常的病例，即消退性睾丸混合生殖细胞肿瘤表现为原发性胰腺肿瘤。胰腺肿块的细胞学特征不具特异性，增加了胰腺原发性未分化癌的可能性。绒毛膜癌的特征性组织学表现使得在冰冻切片时做出了正确诊断。随后对睾丸肿块的切除证实存在囊性和瘢痕化（消退性）混合生殖细胞肿瘤，但无绒毛膜癌证据。
