Lou Qitian, Wang Weigen, Liang Wenjie
Department of Radiology, Ninghai First Hospital, Ninghai, Ningbo, Zhejiang.
Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2020 Feb;99(7):e19170. doi: 10.1097/MD.0000000000019170.
Primary retroperitoneal germ cell tumors are uncommon and especially rare in female patients. However, this type should be included in the differential diagnosis of retroperitoneal tumors that may metastasize from the gonads and be a primary tumor.
An abdominal mass was detected in a 38-year-old woman during physical examination, which was accompanied by left renal obstructive hydrops. She was admitted to our institution for further investigation. The patient had no obvious clinical symptoms, and the levels of serum tumor markers did not signifificantly increase. Abdominal noncontrast enhanced and contrast-enhanced computed tomography revealed a retroperitoneal neoplasm that invaded the left ureter, thereby causing left hydronephrosis.
Imaging examination characterized the tumor as malignant based on its invasion in the left ureter. Histopathology and immunohistochemistry confifirmed the resected tumor as a dysgerminoma. The primary gonad-derived germ cell tumor was not found in the pelvis; therefore, the patient was fifinally diagnosed with primary retroperitoneal germ cell tumor.
Preoperative examination was completed, and the retroperitoneal mass was resected.
During the short-term follow-up, no tumor recurrence was detected.
Primary retroperitoneal seminoma should be included in the differential diagnosis of primary retroperitoneal tumors in female patients. The primary retroperitoneal seminoma/anaplastic tumor has an obvious occupying effect and can easily invade the surrounding structures. However, surgical resection of such tumors is an optional treatment strategy.
原发性腹膜后生殖细胞肿瘤并不常见,在女性患者中尤为罕见。然而,在鉴别诊断可能来自性腺转移的腹膜后肿瘤及原发性肿瘤时,应考虑到这种类型。
一名38岁女性在体检时发现腹部肿块,伴有左肾梗阻性积水。她因进一步检查入住我院。患者无明显临床症状,血清肿瘤标志物水平无显著升高。腹部平扫及增强CT显示腹膜后肿瘤侵犯左输尿管,导致左肾积水。
影像学检查根据肿瘤侵犯左输尿管将其判定为恶性。组织病理学和免疫组化证实切除的肿瘤为无性细胞瘤。盆腔未发现原发性性腺来源的生殖细胞肿瘤;因此,患者最终被诊断为原发性腹膜后生殖细胞肿瘤。
完成术前检查后,切除腹膜后肿块。
短期随访期间未发现肿瘤复发。
原发性腹膜后精原细胞瘤应纳入女性患者原发性腹膜后肿瘤的鉴别诊断。原发性腹膜后精原细胞瘤/间变性肿瘤有明显占位效应,易侵犯周围结构。然而,手术切除此类肿瘤是一种可选择的治疗策略。