Janowitz Tobias, Welsh Sarah, Warren Anne Y, Robson Jane, Thomas Benjamin, Shaw Ashley, Ainsworth Nicola L, Neal David E, Mazhar Danish
Oncology Department, Addenbrookes Hospital, Hills Road, Box193, Cambridge, CB2 OQQ, UK.
Cancer Research UK Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Robinson Way, Cambridge, CB2 0RE, UK.
BMC Res Notes. 2015 Oct 1;8:524. doi: 10.1186/s13104-015-1445-9.
Non-seminomatous germ cell tumours make up about 40 % of all germ cell tumours, which in turn are the most common tumours in men aged 15-44 years. Low risk stage I non-seminomatous germ cell tumours, which are confined to the testes, are commonly treated by orchiectomy and surveillance. Up to 20 % of patients with this diagnosis relapse, usually within 1-2 years of follow up, but very rarely after more than 5 years. The most common sites of relapse are the retroperitoneal lymph nodes, the mediastinum, and the lungs. We describe a case of relapse in the prostate over 20 years after initial diagnosis, which has not been described in the literature so far.
This report presents a 49-year-old white British man with relapsed testicular non-seminomatous germ cell tumour 22 years after initial treatment with orchidectomy only. He relapsed with a prostatic mass, haematospermia and back pain. His prostate specific antigen levels were within normal range. Alpha feto-protein and lactate dehydrogenase levels were elevated, and his human chorionic gonadotrophin levels were normal. A biopsy confirmed undifferentiated malignant tumour, shown immunohistochemically to be a yolk sac tumour. The patient was initially treated with bleomycin, etoposide and cisplatin chemotherapy, but developed bleomycin-related pulmonary side effects after two cycles. His treatment was changed and he completed four cycles of chemotherapy by receiving two cycles of etoposide, ifosfamide, and cisplatin. Post treatment blood tumour markers were normal, but a follow up computed tomography showed a mass in the base of the prostate, the trigone and the left distal ureter which was surgically resected. The histology from the surgical resection was of necrotic tissue. The patient is now in follow up at 3 years after treatment with no evidence of residual disease on computed tomography. His Alpha feto-protein, beta human chorionic gonadotrophin and lactate dehydrogenase levels are normal.
Very late relapse in stage I non-seminomatous germ cell tumours is extremely rare and the prostate is a highly unusual site of relapsed disease. For diagnosis of late relapse, this case confirms the value of serum biomarkers in germ cell tumours, in particular non-seminomatous germ cell tumours.
非精原细胞瘤性生殖细胞肿瘤约占所有生殖细胞肿瘤的40%，而生殖细胞肿瘤又是15 - 44岁男性中最常见的肿瘤。局限于睾丸的低风险I期非精原细胞瘤性生殖细胞肿瘤通常采用睾丸切除术和监测进行治疗。高达20%的此类诊断患者会复发，通常在随访的1 - 2年内，但超过5年后复发的情况非常罕见。最常见的复发部位是腹膜后淋巴结、纵隔和肺部。我们描述了一例在初次诊断20多年后前列腺复发的病例，这在迄今为止的文献中尚未有过描述。
本报告介绍了一名49岁的英国白人男性，在仅接受睾丸切除术后22年，睾丸非精原细胞瘤性生殖细胞肿瘤复发。他因前列腺肿块、血精和背痛复发。他的前列腺特异性抗原水平在正常范围内。甲胎蛋白和乳酸脱氢酶水平升高，而人绒毛膜促性腺激素水平正常。活检证实为未分化恶性肿瘤，免疫组化显示为卵黄囊瘤。患者最初接受博来霉素、依托泊苷和顺铂化疗，但两个周期后出现了与博来霉素相关的肺部副作用。他的治疗方案改变，通过接受两个周期的依托泊苷、异环磷酰胺和顺铂完成了四个周期的化疗。治疗后血液肿瘤标志物正常，但后续的计算机断层扫描显示前列腺底部、三角区和左远端输尿管有一个肿块，该肿块经手术切除。手术切除的组织学检查为坏死组织。患者目前在治疗后3年进行随访，计算机断层扫描未发现残留疾病的证据。他的甲胎蛋白、β - 人绒毛膜促性腺激素和乳酸脱氢酶水平正常。
I期非精原细胞瘤性生殖细胞肿瘤的极晚期复发极为罕见，前列腺是复发疾病极不寻常的部位。对于晚期复发的诊断，本病例证实了血清生物标志物在生殖细胞肿瘤，尤其是非精原细胞瘤性生殖细胞肿瘤中的价值。
