Komori Koji, Takahari Daisuke, Kimura Kenya, Kinoshita Takashi, Ito Seiji, Abe Tetsuya, Senda Yoshiki, Misawa Kazunari, Ito Yuichi, Uemura Norihisa, Natsume Seiji, Kawakami Jiro, Iwata Yoshinori, Tsutsuyama Masayuki, Shigeyoshi Itaru, Akazawa Tomoyuki, Hayashi Daisuke, Ouchi Akira, Shimizu Yasuhiro
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan; Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
Case Rep Gastroenterol. 2016 May 19;10(1):193-8. doi: 10.1159/000446017. eCollection 2016 Jan-Apr.
A germ cell tumor is the most common form of malignancy in early male life, and can be classified as either seminomatous or nonseminomatous. Choriocarcinoma, comprised of nonseminomatous germ cells, is the most aggressive type of germ cell tumor and characteristically metastasizes to the retroperitoneal lymph nodes and less frequently to the lungs, liver, bone or brain [Shibuya et al., 2009;48: 551-554]. A 56-year-old man was admitted to another hospital complaining of abdominal distension. Symptoms included anorexia, vomiting, and diarrhea. The patient was diagnosed with an extragonadal germ cell tumor and referred to our hospital to receive chemotherapy. The day after admission, the patient's abdominal distension gradually worsened. An emergency operation revealed venous hemorrhage from the surface of a metastatic extragonadal germ cell tumor between the ligament of Treitz and the inferior mesenteric vein in a horizontal position. Hemostatic treatment was performed with 4-0 proline thread attached to a medicated cotton sponge, rather than using a simple proline thread, and the closure area was manually compressed. Chemotherapy was initiated on postoperative day 10. A metastatic extragonadal germ cell tumor that causes massive hemorrhage and gastrointestinal hemorrhage is very rare, and represents a life-threatening emergency. If the patient's condition carries a substantial risk of bleeding to death, it may be worthwhile to attempt abdominal operations.
生殖细胞肿瘤是男性早期最常见的恶性肿瘤形式，可分为精原细胞瘤或非精原细胞瘤。绒毛膜癌由非精原生殖细胞组成，是最具侵袭性的生殖细胞肿瘤类型，其特征是转移至腹膜后淋巴结，较少转移至肺、肝、骨或脑[Shibuya等人，2009年；48:551 - 554]。一名56岁男性因腹胀被收治于另一家医院。症状包括厌食、呕吐和腹泻。该患者被诊断为性腺外生殖细胞肿瘤，并转诊至我院接受化疗。入院次日，患者腹胀逐渐加重。急诊手术发现，在水平位的Treitz韧带与肠系膜下静脉之间的转移性性腺外生殖细胞肿瘤表面有静脉出血。止血治疗使用附着在药棉海绵上的4-0脯氨酸线，而非单纯使用脯氨酸线，并对缝合区域进行手动压迫。术后第10天开始化疗。导致大量出血和胃肠道出血的转移性性腺外生殖细胞肿瘤非常罕见，是危及生命的紧急情况。如果患者病情有大出血致死的重大风险，尝试腹部手术可能是值得的。
