Matabuena-Tamez Pedro, Canepa-Fernández Patricio, Valencia-García Luis César, Gutiérrez-Samperio César, Gallegos-Corona Marco Alonso
Servicio de Cirugía Oncológica, Hospital Regional de Zona 1, Instituto Mexicano del Seguro Social, Santiago de Querétaro, Querétaro, México.
Facultad de Medicina, Universidad Autónoma de Querétaro, Santiago de Querétaro, Querétaro, México.
Cir Cir. 2015 Nov-Dec;83(6):527-31. doi: 10.1016/j.circir.2015.05.035. Epub 2015 Jul 9.
Testicular germ-cell carcinoma is the most frequent neoplasm in males aged 15 to 35 years old. It is bilateral in 2% to 3%, and synchronous in 20% to 25% of the cases.
The case is presented of a 19 year-old male, with abdominal pain. Physical examination revealed abdominal mass in the umbilical region, and the computed tomography scan showed a retroperitoneal tumour, with α-fetoprotein, lactate dehydrogenase, and human chorionic gonadotropin above limits. Testicular ultrasound showed bilateral lesions. Exploratory laparotomy was performed, identifying an unresectable retroperitoneal tumour. Biopsies were taken, reporting mixed germ cell tumour composed of choriocarcinoma and embryonal carcinoma. Six cycles of chemotherapy were given, based on bleomycin, etoposide and cisplatin, with partial tumour response. Later on, the patient underwent bilateral radical orchiectomy, with pathology reporting a synchronous bilateral testicular teratoma. A second line of chemotherapy was given, based on vincristine, etoposide, ifosfamide and cisplatinum. Nevertheless, the disease progressed, with metastatic dissemination and the patient died.
Germ cells tumours can present in primary extra-gonadal locations. It is difficult to distinguish a retroperitoneum primary germ cell tumour from metastatic disease of a clinically undetected gonadal tumour or one that has regressed, like the situation described in the case presented.
Ninety percent of patients diagnosed with germ cell tumours can be cured. However, delay in diagnosis correlates with an advanced clinical stage and poor prognosis.
睾丸生殖细胞癌是15至35岁男性中最常见的肿瘤。2%至3%为双侧发病，20%至25%为同步发病。
本文介绍了一名19岁男性，有腹痛症状。体格检查发现脐区有腹部肿块，计算机断层扫描显示腹膜后肿瘤，甲胎蛋白、乳酸脱氢酶和人绒毛膜促性腺激素高于正常范围。睾丸超声显示双侧病变。进行了剖腹探查术，发现一个无法切除的腹膜后肿瘤。取了活检，报告为混合性生殖细胞肿瘤，由绒毛膜癌和胚胎癌组成。基于博来霉素、依托泊苷和顺铂进行了六个周期的化疗，肿瘤有部分反应。后来，患者接受了双侧根治性睾丸切除术，病理报告为同步双侧睾丸畸胎瘤。基于长春新碱、依托泊苷、异环磷酰胺和顺铂进行了二线化疗。然而，疾病进展，出现转移扩散，患者死亡。
生殖细胞肿瘤可原发于性腺外部位。很难将腹膜后原发性生殖细胞肿瘤与临床上未检测到的性腺肿瘤的转移性疾病或已消退的性腺肿瘤区分开来，就像本文所述病例的情况一样。
90%被诊断为生殖细胞肿瘤的患者可以治愈。然而，诊断延迟与临床晚期和预后不良相关。
