Dorfinger K, Kratzik C, Madersbacher S, Dorfinger G, Berger P, Marberger M
Department of Urology, University of Vienna, Austria.
J Urol. 1997 Sep;158(3 Pt 1):851-5. doi: 10.1097/00005392-199709000-00042.
We evaluated the presence of human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and a panel of other tumor markers in the compartment next to the tumor (that is, the malignant hydrocele fluid).
We measured hCG, AFP, neuron-specific enolase, carcinoembryonic antigen and cytokeratin-19 fragments in cubital vein sera and in hydrocele fluids of patients with testicular cancer. Results were compared with those obtained from hydrocele fluids of patients with benign disease.
All tumor markers remained under the respective cutoff values in benign hydroceles. In patients with pure seminomas, hCG levels were elevated in 66% of hydroceles but only once in peripheral sera, whereas AFP remained low in both compartments. Furthermore, of 11 cases of nonseminomatous germ cell tumor hydrocele fluids, 3 with negative peripheral tumor marker values had to be reclassified marker positive, of which 2 showed elevated hCG levels and 1 had increased levels of AFP. Significant changes of neuron-specific enolase and carcinoembryonic antigen concentrations could not be observed. However, a cytokeratin-19 fragment measured by Cyfra 21-1 assay was elevated in 2 of 3 seminomatous and in 4 of 8 nonseminomatous hydroceles.
These data give a new insight into the in vivo secretion pattern of testicular germ cell neoplasms, which demonstrates that the term "marker negative" should be restricted to selected cases of testicular cancer. Analysis of tumor markers in hydrocele fluids may be a helpful tool in patients with scrotal swelling if clinical and sonographic results remain uncertain.
我们评估了肿瘤旁腔隙（即恶性鞘膜积液）中人类绒毛膜促性腺激素（hCG）、甲胎蛋白（AFP）及一组其他肿瘤标志物的存在情况。
我们检测了睾丸癌患者肘静脉血清和鞘膜积液中的hCG、AFP、神经元特异性烯醇化酶、癌胚抗原和细胞角蛋白19片段。将结果与良性疾病患者鞘膜积液的检测结果进行比较。
在良性鞘膜积液中，所有肿瘤标志物均低于各自的临界值。在纯精原细胞瘤患者中，66%的鞘膜积液中hCG水平升高，但外周血清中仅1次升高，而两个腔隙中的AFP水平均较低。此外，在11例非精原细胞性生殖细胞肿瘤鞘膜积液病例中，3例外周肿瘤标志物值为阴性的病例不得不重新分类为标志物阳性，其中2例hCG水平升高，1例AFP水平升高。未观察到神经元特异性烯醇化酶和癌胚抗原浓度的显著变化。然而，通过Cyfra 21-1检测法测定的细胞角蛋白19片段在3例精原细胞瘤中的2例以及8例非精原细胞瘤中的4例中升高。
这些数据为睾丸生殖细胞肿瘤的体内分泌模式提供了新的见解，表明“标志物阴性”一词应仅限于某些特定的睾丸癌病例。如果临床和超声检查结果仍不确定，分析鞘膜积液中的肿瘤标志物可能是阴囊肿胀患者的一种有用工具。
