Chiba W, Matsubara Y, Sawai S, Konishi T, Ishida H, Hanawa T, Kosaba S, Ikeda S
Respiratory Division, Kyoto-Katsura Hospital, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1993 Jan;31(1):94-8.
A 23-year-old female was admitted to our hospital because of a mediastinal tumor. She complained of primary amenorrhea, and abdominal echosonography was therefore performed, revealing the absence of a uterus. Chromosome analysis revealed a 46 XY genotype, indicating the patient to be a male, not a female. Left renal venography demonstrated residual blood vessels originating in the Mullerian ducts. Thoracotomy and laparotomy were performed, and the mediastinal tumor and bilateral testes were resected. Postoperative pathology revealed that the mediastinal tumor was a neurinoma. There was no spermatogenesis, but hyperplasia of Sertoli cells in the testes was seen. Neither the neurinoma nor the testes were malignant. Bioassay of the testes showed no androgen receptors, leading to the diagnosis of testicular feminization syndrome with the complete form of androgen insensitivity. There have been many reports of an association between testicular feminization syndrome and malignant tumors of the testes, but few reports of an association between testicular feminization syndrome and benign tumors such as neurinoma. Accordingly, the present case was considered to be unusual and worth reporting.
一名23岁女性因纵隔肿瘤入院。她主诉原发性闭经,因此进行了腹部超声检查,结果显示子宫缺如。染色体分析显示为46,XY基因型,表明该患者为男性而非女性。左肾静脉造影显示有起源于苗勒管的残余血管。遂进行了开胸手术和剖腹手术,切除了纵隔肿瘤和双侧睾丸。术后病理显示纵隔肿瘤为神经鞘瘤。睾丸内未见精子发生,但可见支持细胞增生。神经鞘瘤和睾丸均无恶性病变。睾丸生物检测显示无雄激素受体,从而诊断为完全型雄激素不敏感的睾丸女性化综合征。已有许多关于睾丸女性化综合征与睾丸恶性肿瘤之间关联的报道,但关于睾丸女性化综合征与神经鞘瘤等良性肿瘤之间关联的报道很少。因此,本病例被认为不寻常且值得报道。