Wood A, Robson N, Tung K, Mead G
Department of Radiology, Royal South Hants Hospital, Southampton, UK.
Clin Radiol. 1996 Apr;51(4):273-6. doi: 10.1016/s0009-9260(96)80345-x.
The imaging and clinical findings of 31 patients with supradiaphragmatic nodal metastases from primary testicular germ cell cancers were reviewed. In 11 patients the primary testicular tumor was a seminoma, and in 20 a non-seminomatous germ cell tumour (NSGCT). The patterns of spread of these tumour types were compared. All patients had chest radiographs (CXR): 27 had chest computed tomography (CT). One patient with seminoma and eight with NSGCT (40%) had lung metastases. Mediastinal lymphadenopathy was seen on CT in seven patients with seminoma (64%) and in nine patients with NSGCT (45%). Neck lymphadenopathy was present in 10 of 11 (91%) patients with seminoma, and 13 of 20 (65%) patients with NSGCT. Neck disease co-existed with mediastinal disease in six of 11 (55%) patients with seminoma, but in only two of 20 (10%) patients with NSGCT (P=0.012). This study gives further supporting evidence for the relative importance of haematogenous spread in teratoma, and lymphatic spread in seminoma. The contiguous nature of disease spread from abdomen to chest and neck in seminoma is confirmed. In NSGCT, supradiaphragmatic spread is more random but tends to occur in the paraoesophageal and subcarinal groups.
对31例原发性睾丸生殖细胞癌膈上淋巴结转移患者的影像学和临床资料进行了回顾性分析。11例患者的原发性睾丸肿瘤为精原细胞瘤，20例为非精原细胞性生殖细胞肿瘤（NSGCT）。比较了这些肿瘤类型的扩散模式。所有患者均行胸部X线检查（CXR）：27例行胸部计算机断层扫描（CT）。1例精原细胞瘤患者和8例NSGCT患者（40%）发生肺转移。CT检查发现7例精原细胞瘤患者（64%）和9例NSGCT患者（45%）有纵隔淋巴结肿大。11例精原细胞瘤患者中有10例（91%）出现颈部淋巴结肿大，20例NSGCT患者中有13例（65%）出现颈部淋巴结肿大。11例精原细胞瘤患者中有6例（55%）颈部病变与纵隔病变并存，而20例NSGCT患者中只有2例（10%）并存（P=0.012）。本研究进一步支持了血行转移在畸胎瘤中相对重要，而淋巴转移在精原细胞瘤中相对重要的观点。证实了精原细胞瘤中疾病从腹部向胸部和颈部连续扩散的特点。在NSGCT中，膈上扩散更随机，但倾向于发生在食管旁和隆突下组。
