Hagiuda Jun, Matsumoto Mayuko, Hanawa Yasumasa, Ishikawa Hiromichi, Marumo Ken
Department of Urology, Tokyo Dental College, Ichikawa General Hospital.
Nihon Hinyokika Gakkai Zasshi. 2010 Nov;101(7):749-53. doi: 10.5980/jpnjurol.101.749.
Adenocarcinoma of the rete testis is a rare malignant tumor with a poor prognosis. About 60 cases of this adenocarcinoma have been reported in the literature. The diagnosis is often difficult and made incidentally. Herein, we report a case of adenocarcinoma of the rete testis and review the literature. Our patient was an 80-year-old man who presented with painless scrotal swelling for 2 years. Physical examination revealed an enlarged, hard mass of the left scrotum. The serum markers alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (beta-HCG), and carcinoembryonic antigen (CEA) were negative. Magnetic resonance imaging (MRI) showed a left hydrocele with central necrosis of the testis. After 4 months, the patient presented with appetite loss, general fatigue, and pain in the left scrotum. Positron emission tomography (PET) was performed in another hospital, and the patient was referred for a left testicular tumor, multiple lung metastases, and para-aorta lymph node metastasis. The patient underwent left high inguinal orchiectomy. Pathological examination revealed a hard whitish mass around the testis involving the epididymis and tunica vaginalis and spreading under the subcutaneous tissue. Histological examination revealed adenocarcinoma in the hilum of the testis, which extended to the subcutaneous tissue but not to the surface of the scrotum. The tunica albuginea was intact, and no invasion of carcinoma in the testis was seen. After the histological diagnosis of adenocarcinoma of the rete testis was confirmed, computed tomography (CT) was performed and showed multiple pulmonary nodules and para-aortica lymph node swelling of 3 cm diameter. Because the patient did not wish to receive chemotherapy or other aggressive treatment, he has been followed-up with palliative care since his diagnosis. Although local recurrence has occurred 4 months later, he is still alive for 8 months since his diagnosis.
睾丸网腺癌是一种罕见的恶性肿瘤，预后较差。文献中已报道约60例这种腺癌。诊断往往困难且多为偶然发现。在此，我们报告一例睾丸网腺癌病例并复习相关文献。我们的患者是一名80岁男性，出现无痛性阴囊肿胀2年。体格检查发现左侧阴囊有一个增大、坚硬的肿块。血清标志物甲胎蛋白（AFP）、β-人绒毛膜促性腺激素（β-HCG）和癌胚抗原（CEA）均为阴性。磁共振成像（MRI）显示左侧鞘膜积液伴睾丸中央坏死。4个月后，患者出现食欲减退、全身乏力和左侧阴囊疼痛。在另一家医院进行了正电子发射断层扫描（PET），结果显示患者患有左侧睾丸肿瘤、多发肺转移和腹主动脉旁淋巴结转移。患者接受了左侧高位腹股沟睾丸切除术。病理检查发现睾丸周围有一个坚硬的白色肿块，累及附睾和鞘膜，并蔓延至皮下组织。组织学检查显示睾丸门部为腺癌，已延伸至皮下组织，但未累及阴囊表面。白膜完整，未见癌侵犯睾丸。在确诊为睾丸网腺癌后，进行了计算机断层扫描（CT），显示多发肺结节和直径3 cm的腹主动脉旁淋巴结肿大。由于患者不愿接受化疗或其他积极治疗，自诊断以来一直接受姑息治疗随访。尽管4个月后出现了局部复发，但自诊断以来他仍存活了8个月。
