Okumura Yoshinaga, Oae Masashi, Shiraishi Yusuke, Soda Takeshi, Kanamaru Hiroshi, Arima Nobuyoshi
The Department of Urology, Kitano Hospital.
The Department of Hematology, Kitano Hospital.
Hinyokika Kiyo. 2016 May;62(5):271-4.
A 27-year-old man visited our hospital with painless swelling of the left scrotum. Hematologic studies showed the following levels of lactate dehydrogenase, 3,171 IU/l ; alpha-fetoprotein, 2.2 ng/ml ; and β- human chorionic gonadotropin, 0.4 ng/ml, and abdominal computed tomography revealed a mass of 10×8 ×4 cm in the left testis, and that of 3.5×3.0×5.0 cm in the left renal hilar lymph node, without any other metastasis. Left high inguinal orchiectomy was performed, and histopathological examination revealed mixed form with seminoma and teratoma. He was diagnosed to have a left germ cell tumor with left renal hilar lymph node metastases, pT1, N3, M0, stage II C, indicating poor prognosis with IGCCC. The patient received four cycles of chemotherapy, COMPE regimen (CDDP, VCR, MTX, PEP, VP-16 [etoposide]). After lactate dehydrogenase, alpha-fetoprotein, and β -human chorionic gonadotropin all normalized, retroperitoneal lymph node dissection was performed. Histopathological examination revealed only a mature teratoma. Two and half years later, hematologic studies showed blast transformation. Bone marrow biopsy revealed acute myeloblastic lymphoma (M2). The patient received one cycle of AraC and daunorubicin, one cycle of high dose AraC, and three cycles of AraC and mitoxantrone. After chemotherapy, he has maintained a disease-free status for 11 years. In this case, etoposide, a topoisomerase II inhibitor, was the presumed cause of therapy-related acute myeloid leukemia. After administering chemotherapeutic agents especially etoposide, it is important to check blood count periodically for a long time.
一名27岁男性因左侧阴囊无痛性肿胀前来我院就诊。血液学检查显示乳酸脱氢酶水平为3171 IU/l；甲胎蛋白为2.2 ng/ml；β-人绒毛膜促性腺激素为0.4 ng/ml，腹部计算机断层扫描显示左侧睾丸有一个10×8×4 cm的肿块，左侧肾门淋巴结有一个3.5×3.0×5.0 cm的肿块，无其他转移。进行了左侧高位腹股沟睾丸切除术，组织病理学检查显示为精原细胞瘤和畸胎瘤的混合形式。他被诊断为左侧生殖细胞肿瘤伴左侧肾门淋巴结转移，pT1，N3，M0，II C期，根据国际生殖细胞癌协作组（IGCCC）标准提示预后不良。患者接受了四个周期的化疗，采用COMPE方案（顺铂、长春新碱、甲氨蝶呤、培门冬酶、依托泊苷）。在乳酸脱氢酶、甲胎蛋白和β-人绒毛膜促性腺激素均恢复正常后，进行了腹膜后淋巴结清扫术。组织病理学检查仅发现成熟畸胎瘤。两年半后，血液学检查显示原始细胞转化。骨髓活检显示为急性髓细胞性淋巴瘤（M2）。患者接受了一个周期的阿糖胞苷和柔红霉素、一个周期的大剂量阿糖胞苷以及三个周期的阿糖胞苷和米托蒽醌治疗。化疗后，他已维持无病状态11年。在本病例中，拓扑异构酶II抑制剂依托泊苷被认为是治疗相关急性髓系白血病的病因。在使用化疗药物尤其是依托泊苷后，长期定期检查血细胞计数很重要。
