Lockett Chris J, Nandwani Ghulam M, Stubington Simon R
Department of Urology, Leighton Hospital, Crewe, Cheshire, CW1 4QJ, UK.
BMC Urol. 2006 Mar 1;6:5. doi: 10.1186/1471-2490-6-5.
The route of local and metastatic spread of testicular seminoma is well recognised and accepted. The spread is via lymphatics to the paraaortic nodes.
We present a case report of testicular seminoma in a 56 year old man with previously unreported histological findings. In this case seminoma tumour cells did not appear to have spread by the expected lymphatic route. There was no involvement of retro-peritoneal para-aortic lymph nodes. The tumour appeared to have spread directly along the vas deferans in the sub epithelial plane to the mesenteric lymph nodes.
This type of seminoma tumour spread has not previously been described and it is not a recognised route for metastasis by seminoma tumour. In this case the macroscopic clinical appearance was of a stage I tumour with normal tumour markers. However, the pathological stage of the tumour was surprisingly increased to stage III on the basis of histology and CT radiological findings. We present the unusual histological findings. In view of this unusual histological finding we reinforce the need for accurate staging and for resection of the spermatic cord close to the deep inguinal ring. Accurate staging is crucial in planning the treatment and follow up of seminoma and determines the prognosis.
睾丸精原细胞瘤的局部及转移扩散途径已得到充分认识和认可。其扩散是通过淋巴管至腹主动脉旁淋巴结。
我们报告一例56岁男性睾丸精原细胞瘤病例，具有此前未报道的组织学发现。在此病例中，精原细胞瘤肿瘤细胞似乎未按预期的淋巴途径扩散。腹膜后腹主动脉旁淋巴结未受累。肿瘤似乎是沿输精管在黏膜下层平面直接扩散至肠系膜淋巴结。
这种类型的精原细胞瘤肿瘤扩散此前未被描述过，也不是精原细胞瘤公认的转移途径。在此病例中宏观临床表现为肿瘤标志物正常的I期肿瘤。然而，基于组织学和CT影像学检查结果，肿瘤的病理分期出人意料地升至III期。我们展示了这些不寻常的组织学发现。鉴于这一不寻常的组织学发现，我们强调准确分期以及在靠近腹股沟深环处切除精索的必要性。准确分期对于精原细胞瘤的治疗规划和随访至关重要，并决定预后。
