Terai A, Ishitoya S, Hashimura T, Takeuchi H, Yoshida O
Department of Urology, Faculty of Medicine, Kyoto University, Japan.
Int J Urol. 1995 May;2(2):135-8. doi: 10.1111/j.1442-2042.1995.tb00443.x.
We report a case of testicular yolk sac tumor in a child aged 3 years and 6 months with multiple bulky metastases to lung and retroperitoneum (stage IIIB2). After three courses of chemotherapy with a PVB regimen (cisplatin, vinblastine and bleomycin), complete and partial responses were obtained for lung and retroperitoneal lymph node metastases, respectively. The patient was followed-up closely. However, on the basis of a re-elevated alpha-fetoprotein (AFP) after 4 months' follow-up, he was treated with three courses of salvage chemotherapy with a modified VAB-6 regimen (cyclophosphamide, etoposide, actinomycin D, bleomycin and cisplatin), followed by retroperitoneal lymph node dissection. Histologically, only necrotic tissue was found. There is no evidence of recurrence 24 months after lymphadenectomy. There is very little information in the literature on the appropriate management of postchemotherapy residual mass in pediatric testicular tumors.
我们报告一例3岁6个月儿童的睾丸卵黄囊瘤，伴有肺和腹膜后多发巨大转移灶（ⅢB2期）。采用PVB方案（顺铂、长春碱和博来霉素）进行三个疗程化疗后，肺转移灶和腹膜后淋巴结转移灶分别获得完全缓解和部分缓解。对该患者进行了密切随访。然而，在随访4个月后甲胎蛋白（AFP）再次升高的基础上，对其采用改良VAB - 6方案（环磷酰胺、依托泊苷、放线菌素D、博来霉素和顺铂）进行了三个疗程的挽救性化疗，随后进行了腹膜后淋巴结清扫术。组织学检查仅发现坏死组织。淋巴结切除术后24个月无复发迹象。关于小儿睾丸肿瘤化疗后残留肿块的适当处理，文献中的信息非常少。
