Johnson D E, Appelt G, Samuels M L, Luna M
Urology. 1976 Sep;8(3):234-9. doi: 10.1016/0090-4295(76)90374-5.
The necropsy records of 78 patients with histologically proved germ cell tumors of the testis, who died as a direct result of their malignant disease, were reviewed to determine the usual modes of spread, distribution of metastasis, the histologic characteristics of the metastatic foci as compared with the morphology of the primary tumor and the specific cause of death. The sites of metastases in order of decreasing frequency for all cases were lung, retroperitoneal lymph nodes, liver, mediastinal lymph nodes, brain, kidney, gastrointestinal tract, bones, adrenals, peritoneum and spleen. The absence of metastases solely in the anterior mediastinum without involvement of other mediastinal nodes (middle/posterior) strongly supports the premise for a primary extragonadal origin whenever the anterior mediastinum alone is involved with malignant disease having the histologic appearance of a primary germ cell tumor. The histologic features of the metastatic lesions were usually similar in nature to those of the primary tumor except for seminoma in which the metastatic lesions proved to be of a different histologic pattern in almost one third of the patients dying from the disease. It should be axiomatic that whenever a patient with seminoma fails to respond appropriately to radiotherapy that his treatment be immediately discontinued and that appropriate biopsies be obtained to substantiate the histologic pattern present.
对78例经组织学证实为睾丸生殖细胞瘤且因恶性疾病直接死亡的患者尸检记录进行回顾，以确定常见的扩散方式、转移分布、转移灶的组织学特征与原发肿瘤形态的比较以及具体死亡原因。所有病例转移部位按频率递减顺序依次为肺、腹膜后淋巴结、肝、纵隔淋巴结、脑、肾、胃肠道、骨、肾上腺、腹膜和脾。仅前纵隔出现转移而无其他纵隔淋巴结（中/后）受累，强烈支持了只要前纵隔单独出现具有原发生殖细胞瘤组织学表现的恶性疾病，其起源为原发性腺外的前提。转移灶的组织学特征通常与原发肿瘤相似，但精原细胞瘤除外，在几乎三分之一死于该病的患者中，转移灶的组织学模式与原发肿瘤不同。不言而喻的是，每当精原细胞瘤患者对放疗无适当反应时，应立即停止治疗，并进行适当活检以证实存在的组织学模式。
