Leibovitch I, Foster R S, Ulbright T M, Donohue J P
Department of Urology, Indiana University School of Medicine, Indianapolis, USA.
Cancer. 1995 May 1;75(9):2244-50. doi: 10.1002/1097-0142(19950501)75:9<2244::aid-cncr2820750909>3.0.co;2-i.
Pure testicular teratoma in adults is a relatively rare malignant tumor with the ability to invade and metastasize. Pure teratoma generally is believed to be less aggressive and less likely to progress, to present in lower stages, and to have better survival rates then other forms of germ cell tumor. Consequently, clinical stage A patients with pure testicular teratoma commonly have been considered to be managed best by surveillance.
A computerized database search identified 41 patients presenting to Indian University with pure teratoma in the orchiectomy specimen. These patients were further subdivided into four groups based on clinical stage, as follows: Group I, 18 patients with clinical Stage A disease; Group II, 4 patients with clinical Stages A-B1 disease based on questionable computed tomography findings; Group III, 3 patients with clinical Stage B1 disease; Group IV, 16 patients with advanced stage (B3-C) disease. The experience with these patients was reviewed.
The overall risk of lymph node metastasis in retroperitoneal lymph node dissection (RPLND) and the risk of relapse after RPLND for patients with low stage pure testicular teratoma (groups I-III) were 40 and 16%, respectively. In patients with clinical Stage A teratoma, the risk of retroperitoneal metastasis in RPLND was 16.7% and the relapse rate was 11.1%. In addition, nearly 37% of referred patients with pure teratoma presented with advanced disease.
These data provide additional confirmation of the metastatic potential of pure testicular teratoma. The proper management of the adult clinical stage A patient with primary pure teratoma of the testis should not necessarily differ from the management of any other histologic type of nonseminomatous testicular tumor. Accordingly, histologic diagnosis of pure teratoma should not mandate surveillance. Instead, patients must be given adequate information regarding management options, as are all other patients presenting with clinical Stage A nonseminoma.
成人单纯性睾丸畸胎瘤是一种相对罕见的具有侵袭和转移能力的恶性肿瘤。一般认为单纯性畸胎瘤的侵袭性较小，进展的可能性较小，多处于较低分期，生存率优于其他类型的生殖细胞肿瘤。因此，临床分期为A期的单纯性睾丸畸胎瘤患者通常被认为最佳的处理方式是进行观察。
通过计算机数据库检索，确定了41例在印第安纳大学接受睾丸切除术，术后标本中发现单纯性畸胎瘤的患者。根据临床分期，这些患者被进一步分为四组，如下：第一组，18例临床分期为A期疾病的患者；第二组，4例基于可疑的计算机断层扫描结果，临床分期为A - B1期疾病的患者；第三组，3例临床分期为B1期疾病的患者；第四组，16例晚期（B3 - C期）疾病的患者。回顾了这些患者的治疗经历。
低分期单纯性睾丸畸胎瘤（第一组至第三组）患者在腹膜后淋巴结清扫术（RPLND）中发生淋巴结转移的总体风险以及RPLND后复发的风险分别为40%和16%。在临床分期为A期畸胎瘤的患者中，RPLND中腹膜后转移的风险为16.7%，复发率为11.1%。此外，近37%转诊的单纯性畸胎瘤患者表现为晚期疾病。
这些数据进一步证实了单纯性睾丸畸胎瘤的转移潜能。对于原发性睾丸单纯性畸胎瘤的成人临床A期患者，其恰当的处理方式不一定与其他组织学类型的非精原细胞瘤性睾丸肿瘤的处理方式不同。因此，单纯性畸胎瘤的组织学诊断不应强制进行观察。相反，必须像所有其他临床分期为A期非精原细胞瘤的患者一样，为患者提供关于治疗选择的充分信息。
