Department of Medicine, University of British Columbia, Vancouver, Canada.
J Crohns Colitis. 2011 Apr;5(2):162-4. doi: 10.1016/j.crohns.2010.11.002. Epub 2010 Dec 13.
Antitumor necrosis factor alpha (anti-TNFα) agents have substantially altered the management of inflammatory bowel diseases (IBD). Their benefits must however be weighed against increased risks for infections, lymphoma, and possibly other malignancies. We report on a 27-year-old man, with a six-year history of ulcerative colitis maintained on mesalamine suppositories, presenting with clinical, radiographic and biopsy evidence of an acute colitis flare. Due to the refractory nature of his disease, infliximab was started, resulting in induction of remission within six weeks. Three months after the first dose of infliximab, the patient was diagnosed with a testicular mixed germ cell tumor requiring orchiectomy. Four cases of testicular cancer development among patients using anti-TNFα agents have been identified. Given the prevalence of IBD in young men and recent suggestions for "top-down therapy," testicular cancer as a potential complication of anti-TNFα agents should be further explored on a population basis.
肿瘤坏死因子-α（anti-TNFα）拮抗剂的问世显著改变了炎症性肠病（IBD）的治疗模式。然而，在考虑这些药物带来的益处的同时，也必须权衡其增加感染、淋巴瘤，以及其他恶性肿瘤风险的可能性。我们报道了一位 27 岁男性，溃疡性结肠炎病史 6 年，一直使用美沙拉嗪栓剂治疗，因急性结肠炎发作而出现临床、影像学和活检证据。由于疾病的难治性，开始使用英夫利昔单抗治疗，结果在 6 周内诱导缓解。英夫利昔单抗首剂量治疗 3 个月后，患者被诊断为睾丸混合生殖细胞肿瘤，需要行睾丸切除术。已经发现了 4 例使用抗 TNFα 药物的患者发生睾丸癌。鉴于年轻男性中 IBD 的流行以及最近提出的“自上而下的治疗策略”，有必要在人群基础上进一步探讨抗 TNFα 药物引起睾丸癌的潜在并发症。
