Burke A P, Mostofi F K
Department of Genitourinary Pathology, Armed Forces Institute of Pathology, Washington, DC.
Mod Pathol. 1988 Nov;1(6):475-9.
This study was undertaken to determine the clinical course of patients with intratubular malignant germ cells (ITMGCs) and to evaluate the reliability of placental alkaline phosphatase (PLAP) for detection of these cells. Eight patients with ITMGCs in testicular biopsy were followed. Four patients received no further immediate treatment. Two of these showed no evidence of disease after 190 and 132 mo; one developed seminoma at 38 mo, and one developed seminoma of the contralateral testis in 61 mo. The remaining four patients underwent immediate orchiectomy. Orchiectomy findings were invasive seminoma in three testes, intratubular seminoma in one, and residual ITMGCs in one testis (one patient had bilateral orchiectomy). Also studied were two testicular biopsies from patients with known retroperitoneal germ cell tumors, respectively, seminoma and teratoma. Both had ITMGCs in their testes. Immunoperoxidase stains for PLAP gave a positive result in all biopsies showing intratubular malignant germ cells. PLAP was not demonstrated in spermatogonia in 471 control biopsies which did not show germ cell neoplasia. Two other patients with incidental seminoma on biopsy for infertility are discussed. These results show that ITMGCs show a high rate of progression to invasive disease, but can show an indolent course. PLAP is a sensitive and specific marker for ITMGC, facilitating diagnosis.
本研究旨在确定睾丸内恶性生殖细胞（ITMGCs）患者的临床病程，并评估胎盘碱性磷酸酶（PLAP）检测这些细胞的可靠性。对8例睾丸活检发现ITMGCs的患者进行了随访。4例患者未立即接受进一步治疗。其中2例在190个月和132个月后未发现疾病迹象；1例在38个月时发生精原细胞瘤，1例在61个月时对侧睾丸发生精原细胞瘤。其余4例患者立即接受了睾丸切除术。睾丸切除术后发现，3个睾丸为浸润性精原细胞瘤，1个为睾丸内精原细胞瘤，1个睾丸有残留的ITMGCs（1例患者接受了双侧睾丸切除术）。还分别对2例已知腹膜后生殖细胞肿瘤患者的睾丸活检进行了研究，肿瘤分别为精原细胞瘤和畸胎瘤。二者睾丸中均有ITMGCs。对所有显示睾丸内恶性生殖细胞的活检组织进行PLAP免疫过氧化物酶染色，结果均为阳性。在471例未显示生殖细胞肿瘤的对照活检组织的精原细胞中未检测到PLAP。还讨论了另外2例因不育进行活检时意外发现精原细胞瘤的患者。这些结果表明，ITMGCs发展为浸润性疾病的发生率较高，但也可能呈惰性病程。PLAP是ITMGC的一种敏感且特异的标志物，有助于诊断。
