Hamano Itsuto, Hatakeyama Shingo, Nakamura Rika, Fukuhara Rie, Noro Daisuke, Seino Hiroko, Yoneyama Takahiro, Hashimoto Yasuhiro, Koie Takuya, Yokoyama Yoshihito, Ohyama Chikara
1Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562 Japan.
2Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Basic Clin Androl. 2018 Jan 25;28:1. doi: 10.1186/s12610-018-0066-2. eCollection 2018.
Although oncologic testicular sperm extraction (onco-TESE) has been increasingly practiced, the evidence of onco-TESE performed in patients with testicular cancer is insufficient. Furthermore, in bilateral testicular cancer, accounting for 0.5%-1% of testicular cancers, onco-TESE is more challenging and has been insufficiently reported.
Here we report the case of a 25-year-old man who underwent onco-TESE from his residual single testis with a nonseminomatous germ cell tumor that occurred 5 years after orchiectomy of the contralateral testis. A second orchiectomy and simultaneous TESE from the noncancerous testicular tissue were performed. The pathological diagnosis was germ cell tumors, tumors of more than one histological type (embryonal carcinoma, immature teratoma, yolk sac tumor, seminoma, and choriocarcinoma; pT1N0M0). The patient subsequently married and hoped for fatherhood 3 years later. Whereas histological diagnosis of the normal testicular tissue was Johnsen score 6 (maturation arrest), morphologically normal and motile sperms were successfully retrieved from thawed TESE samples and used for multiple cycles of intracytoplasmic sperm injection. Although the conception has not been succeeded to date, ICSI attempts have been continuing.
This case demonstrates the effectiveness of onco-TESE for challenging cases such as bilateral and nonseminmatous testicular cancer.
尽管肿瘤性睾丸精子提取术（onco - TESE）的应用越来越广泛，但关于睾丸癌患者进行onco - TESE的证据并不充分。此外，双侧睾丸癌占睾丸癌的0.5% - 1%，在此类患者中进行onco - TESE更具挑战性，且相关报道不足。
我们在此报告一名25岁男性的病例，该患者在对侧睾丸切除术后5年，因非精原细胞性生殖细胞肿瘤接受了onco - TESE，手术取自其残余的单个睾丸。随后进行了第二次睾丸切除术，并同时从非癌性睾丸组织中进行了睾丸精子提取术（TESE）。病理诊断为生殖细胞肿瘤，具有多种组织学类型（胚胎癌、未成熟畸胎瘤、卵黄囊瘤、精原细胞瘤和绒毛膜癌；pT1N0M0）。患者随后结婚，并在3年后希望生育。正常睾丸组织的组织学诊断为约翰森评分6分（成熟停滞），但从解冻的TESE样本中成功获取了形态正常且有活力的精子，并用于多次卵胞浆内单精子注射周期。尽管迄今为止尚未成功受孕，但卵胞浆内单精子注射尝试仍在继续。
该病例证明了onco - TESE对于双侧和非精原性睾丸癌等具有挑战性的病例的有效性。
