School of Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan.
Jpn J Clin Oncol. 2013 Jan;43(1):83-6. doi: 10.1093/jjco/hys178. Epub 2012 Nov 6.
We report the case of a 22-year-old male who had a history of metastatic right testicular tumor successfully treated with chemotherapy and surgery. Twenty-one months after the initial treatment, the serum human chorionic gonadotropin started to increase gradually, but whole body imaging including the left testis revealed no abnormal finding except testicular microlithiasis. A biopsy of the left testis revealed intratubular germ cell neoplasia, unclassified type. After the human chorionic gonadotropin level reached 6.6 mIU/ml, he underwent left high orchiectomy. Histology demonstrated a small malignant germ cell tumor as well as intratubular germ cell neoplasia, unclassified type, both of which were negative for human chorionic gonadotropin staining. Besides these lesions, there were tiny foci of human chorionic gonadotropin-immunoreactive intratubular trophoblasts. Serum human chorionic gonadotropin normalized immediately after the orchiectomy, and he had no sign of recurrence at 6 months. The present case will provide new insight into the diagnosis of testicular tumor recurrence with isolated elevation of a serum tumor marker.
我们报告了一例 22 岁男性的病例，该患者右侧睾丸转移性肿瘤病史，经化疗和手术成功治疗。初始治疗后 21 个月，血清人绒毛膜促性腺激素开始逐渐升高，但全身成像（包括左侧睾丸）除了睾丸微石症外没有发现异常。左侧睾丸活检显示未分类型的睾丸内生殖细胞肿瘤。人绒毛膜促性腺激素水平达到 6.6 mIU/ml 后，他接受了左侧高位睾丸切除术。组织学显示存在小的恶性生殖细胞肿瘤和未分类型的睾丸内生殖细胞肿瘤，两者均对人绒毛膜促性腺激素染色呈阴性。除了这些病变外，还有微小的人绒毛膜促性腺激素免疫反应性的小管内滋养细胞灶。睾丸切除术后，血清人绒毛膜促性腺激素立即恢复正常，6 个月时无复发迹象。本病例将为孤立性血清肿瘤标志物升高的睾丸肿瘤复发的诊断提供新的见解。
