O'Leary C G, Allen J A, O'Brien F, Tuthill A, Power D G
Department of Medical Oncology, Cork University Hospital, Cork, Ireland.
Temple Street Children's University Hospital, Dublin 1, Ireland.
Case Rep Oncol Med. 2016;2016:5471862. doi: 10.1155/2016/5471862. Epub 2016 Oct 17.
A 37-year-old male presented with a traumatic injury to the scrotal region necessitating emergency surgery. Evacuation of a haematoma and bilateral orchidectomy were performed. A left sided nonseminomatous germ cell tumour (NSGCT), predominantly yolk sac, was identified. Microscopic margins were positive for tumour. Initial tumour markers revealed an AFP of 22,854 ng/mL, HCG of <1 mIU/mL, and LDH of 463 IU/L. Eight weeks after surgery, AFP levels remained elevated at 11,646 ng/mL. Computed tomography (CT) scanning demonstrated left inguinal adenopathy, 1.5 cm in max dimension. On review, extensive evidence of scrotal involvement was evident. His tumour was staged as stage IIIC, poor risk NSGCT. He was treated with 4 cycles of bleomycin, etoposide, and cisplatin over a 12-week period. His tumour markers normalised after 3 cycles. There was a marked improvement noted clinically. Follow-up CT scans demonstrated complete resolution of his tumour. He later underwent further surgery to remove a small amount of remaining spermatic cord. Histology revealed no malignant tissue. The patient suffered many complications including testosterone deficiency, osteopenia, infertility, and psychological distress. . A small proportion of testicular cancer may present in an atypical manner. The scrotum and testicle have markedly different embryonic origins and therefore a distinct anatomic separation. As a result the scrotum is not a typical site of spread of testicular cancer. Case reports have been described that were managed in a similar manner with good outcomes. Therefore, even with significant scrotal involvement, if timely and appropriate treatment is administered, complete resolution of the tumour may be achieved.
一名37岁男性因阴囊区域外伤前来就诊，需要进行紧急手术。术中清除了血肿并实施了双侧睾丸切除术。术后病理检查发现左侧非精原细胞性生殖细胞肿瘤（NSGCT），主要为卵黄囊瘤，显微镜下切缘肿瘤阳性。初始肿瘤标志物显示甲胎蛋白（AFP）为22,854 ng/mL，人绒毛膜促性腺激素（HCG）<1 mIU/mL，乳酸脱氢酶（LDH）为463 IU/L。术后8周，AFP水平仍高达11,646 ng/mL。计算机断层扫描（CT）显示左侧腹股沟淋巴结肿大，最大直径为1.5 cm。复查时发现阴囊受累的广泛证据。他的肿瘤分期为IIIC期，高危NSGCT。他在12周内接受了4个周期的博来霉素、依托泊苷和顺铂联合化疗。3个周期后肿瘤标志物恢复正常，临床症状有明显改善。后续CT扫描显示肿瘤完全消退。他后来接受了进一步手术，切除了少量残留的精索。组织学检查未发现恶性组织。该患者出现了许多并发症，包括睾酮缺乏、骨质减少、不育和心理困扰。一小部分睾丸癌可能以非典型方式呈现。阴囊和睾丸具有明显不同的胚胎起源，因此在解剖学上是分离的。因此，阴囊不是睾丸癌典型的转移部位。已有类似病例报告采用相同治疗方式并取得良好疗效。所以，即使阴囊受累严重，但如果给予及时恰当的治疗，肿瘤仍有可能完全消退。
