睾丸生殖细胞肿瘤62例临床分析

目的：探讨睾丸生殖细胞肿瘤的诊断、治疗、预后情况及对性功能的影响。方法：对1992年3月～2006年4月收住院的睾丸生殖细胞肿瘤患者的临床及随访资料进行回顾性分析和总结。结果：精原细胞瘤（sGCT）患者平均发病年龄40．3岁,比非精原细胞瘤（NSGCT）大6．9岁;B超显示,SGCT多表现为低回声,NSGCT多为不均匀回声;两者5年总生存率分别为93．94％、82．35％;疾病或治疗相关性性功能障碍发生率14．29％。结论：①血清肿瘤标志物、超声、腹部CT检查对于睾丸生殖细胞肿瘤的诊断、临床分期及预后判断有一定参考价值。②SGCTI期患者单纯手术与手术加放疗疗效相当,Ⅱ期患者应给予手术加放疗;NSGCT患者应给予手术加化疗等综合治疗。③睾丸肿瘤及相关治疗对性功能影响较小,勃起功能障碍主要与放疗有关。     

睾丸肿瘤42例临床分析

目的提高睾丸肿瘤的诊治水平。方法回顾性分析42例睾丸肿瘤临床资料。结果术后病理诊断:原发性肿瘤34例,继发性肿瘤5例,睾丸旁肿瘤3例。在原发性肿瘤中,生殖细胞肿瘤33例,其中精原细胞瘤19例,非精原细胞瘤14例;非生殖细胞肿瘤1例。5例继发性肿瘤均为恶性淋巴瘤。双侧睾丸肿瘤5例。结论睾丸肿瘤多为生殖细胞肿瘤,生殖细胞肿瘤中精原细胞瘤最常见,良性肿瘤少见;注意自我体检,强化健康意识,利于睾丸肿瘤的早发现、早治疗,提高睾丸肿瘤预后。     

睾丸肿瘤67例临床分析

目的探讨睾丸肿瘤的诊断、治疗和预后情况,提高睾丸肿瘤的诊治水平。方法对2006年1月至2015年12月收住本院的睾丸肿瘤患者的临床及随访资料进行回顾性分析和总结。结果精原细胞瘤患者28例,平均发病年龄39.8岁,非精原细胞性生殖细胞肿瘤患者22例,平均发病年龄23.87岁;其他肿瘤17例。接受以手术切除为主的多模式治疗后,三者5年总生存率分别为87.65%、68.35%和58.8%。结论用以手术切除为主的多模式治疗可提高睾丸肿瘤的生存率。     

52例睾丸肿瘤的诊断体会

本院自１９８７年以来，共治疗睾丸肿瘤５２例，其中２９例为精原细胞瘤，１０例为胚胎癌，４例为混合瘤，另有９例为非生殖细胞肿瘤。诊断主要依靠Ｂ超、手术及病理检查。作者认为使用Ｂ超检查对早期诊断睾丸肿瘤很重要；由于睾丸肿瘤容易发生第二肿瘤，患者必须长期随诊。     

蒙古族睾丸肿瘤35例临床分析

目的:提高对蒙古族睾丸肿瘤的诊断和治疗水平。方法:多中心回顾性分析1990年2月~2004年12月35例蒙古族睾丸肿瘤患者的临床资料。结果:主要症状为无痛性睾丸肿大或结节。平均延误诊断(40.03±53.45)周,16例(45.7%)延迟诊断6个月~5年。睾丸肿瘤病理类型:精原细胞瘤21例(60%),占生殖细胞瘤的67.7%(21/31),非精原细胞瘤10例(28.6%),恶性淋巴瘤2例(5.7%),神经纤维瘤和平滑肌瘤各1例(5.7%)。生殖细胞瘤I期22例,II期2例,III期5例。治疗手段以睾丸肿瘤根治性切除和放疗及化疗为主。随访29例睾丸恶性肿瘤患者2个月~10年,其中精原细胞瘤20例,3、5年生存率分别为95.0%、95.0%;非精原细胞瘤7例,3、5年生存率分别为57.1%、42.8%;2例恶性淋巴瘤患者,1例健在,1例化疗中。结论:本组蒙古族睾丸肿瘤患者精原细胞瘤比例高于一般人群,平均延误诊断时间较长。非精原细胞瘤患者3、5年生存率均低于精原细胞瘤患者。睾丸肿瘤知识的宣教和诊疗技术的提高,有助于改善睾丸肿瘤患者的疗效和预后。     

睾丸肿瘤87例临床分析

目的:提高睾丸肿瘤的诊治水平。方法:对87例睾丸肿瘤患者临床资料进行分析。结果:经手术和病理诊断,生殖细胞肿瘤79例,占睾丸肿瘤的90.1%;其中精原细胞瘤44例,占生殖细胞肿瘤的55.7%;良性肿瘤7例,占睾丸肿瘤的8.1%。非精原细胞性生殖细胞瘤(NSGCT)发病集中在5岁以下和18~40岁;精原细胞瘤发病集中在18岁之后;5~17岁仅1例发生睾丸肿瘤。精原细胞瘤和NSGCT患者3、5年生存率分别为90.6%、81.3%和83.3%、56.7%。结论:①睾丸肿瘤多为生殖细胞肿瘤;②NSGCT发病集中在5岁以下和18~40岁两个年龄段;③精原细胞瘤很少在17岁之前发病;④5~17岁很少有睾丸肿瘤发生;⑤精原细胞瘤3、5年存活率较NSGCT高。     

成人睾丸畸胎瘤的诊治分析(附8例报告)

目的探讨成人睾丸畸胎瘤的临床特点及诊治原则和预后情况,提高对此疾病的认识及处理能力。方法对本单位自2006年1月至2018年5月收治的8例成人睾丸畸胎瘤患者的临床症状、病情特点、实验室及影像学检查、治疗方法及对其随访情况进行回顾性分析并结合文献复习。临床分期Ⅰ_a期5例,Ⅰ_b期2例,Ⅱ_a期1例,患者均按照睾丸肿瘤治疗指南推荐的方案进行根治性睾丸切除术,其中Ⅰ_b期和Ⅱ_a期共3例患者行腹膜后淋巴结清扫术及化疗,化疗采用BEP化疗方案,取得较好疗效。术前监测甲胎蛋白(AFP)及β-人绒毛膜促性腺激素(β-HCG)均升高4例,术前精液指标无明显异常。结果 8例患者均行根治性患侧睾丸切除术,其中3例患者联合行腹膜后淋巴结清扫术及化疗,均顺利完成手术。8例睾丸畸胎瘤患者术后病检提示纯畸胎瘤5例,混合性生殖细胞肿瘤含畸胎瘤成分3例;其中4例为成熟性,4例为非成熟性。术后监测AFP及β-HCG指标无异常。所有患者术后随访1～32个月,平均23个月,现患者一般情况良好。未见肿瘤复发和转移。结论睾丸畸胎瘤与其他睾丸肿瘤临床症状相似,临床无特异性。睾丸畸胎瘤是一种特殊类型的非精原细胞瘤,对放、化疗不敏感,根治切除手术是临床最有效的治疗方法。睾丸彩超及CT有助于肿瘤诊断。术后睾丸病理活检可明确诊断。治疗上采用根治性睾丸切除术为主,Ⅰ_b期以上并提示有淋巴结转移情况需要联合腹膜后淋巴结清扫术或联合化疗。早期睾丸肿瘤根治术后一般不需辅以放疗或化疗,预后良好。按照指南推荐的早期诊断及治疗对睾丸畸胎瘤的预后有重要意义。     

原发性睾丸肿瘤的诊断与治疗

目的：总结原发性睾丸肿瘤的诊断与治疗体会。方法：回顾性分析1990年1月－1999年10月收治的39例原发性睾丸肿瘤的临床资料,其中精原细胞瘤20例（51．3％）,非精原细胞瘤18例（46．1％）,恶性淋巴瘤1例（2．6％）。临床表现以睾丸无痛性肿大为主,B超为低回声或回声不均团块,CT和MRI对诊断腹膜后淋巴结转移及腹腔型隐睾恶变有重要价值。在根治性睾丸切除基础上采取腹膜后淋巴结清扫术、放疗、化疗等综合治疗措施。结果：30例获得随访,随访时间2－5年,随访率为76．9％。除2例Ⅲ期患者死亡外,其余均生存。结论：任何睾丸肿块均应排除肿瘤;B超应列为常规检查方法,CT和MRI有助于临床分期;肿瘤标记物对预后和疗效观察有一定参考价值;治疗方法应根据病理类型和临床分期而定。     

腹腔镜下腹膜后淋巴结清扫术治疗临床Ⅰ期睾丸非精原细胞肿瘤7例报告

目的:探讨腹腔镜下腹膜后淋巴结清扫术治疗临床Ⅰ期睾丸非精原细胞肿瘤的临床经验及疗效。方法:回顾性分析2008年10月～2011年6月7例睾丸非精原细胞癌的临床资料,其中左侧4例,右侧3例,平均年龄(34±11)岁,胚胎癌5例,混合性生殖细胞肿瘤2例。术前临床分期均为I期;7例患者均在根治性睾丸切除术后1周行腹腔镜下腹膜后淋巴结清扫术。结果:所有手术均顺利完成,无中转开放,围手术期无严重并发症。平均手术时(172±35)min,术中平均出血量(43±14)ml,平均切除淋巴结(12±3)个,淋巴结阳性患者2例。术后平均住院时间(6±2)d,术后平均随访(25±10)个月,所有患者术后射精功能正常,肿瘤无局部复发及远处转移。结论:腹腔镜下腹膜后淋巴结清扫术安全、有效,具有创伤小、恢复快等优点,可作为明确诊断和治疗临床Ⅰ期睾丸非精原细胞肿瘤的首选方法。     

男性性腺外生殖细胞肿瘤两例报告并文献复习

目的提高对男性性腺外生殖细胞肿瘤的认识.方法 报告两例男性性腺外生殖细胞肿瘤并复习相关文献.结果 一例患者为纵隔、腹膜后和盆腔非精原细胞肿瘤,经化疗和手术治疗,多次复发并呈浸润性生长,预后差;另一例患者为腹膜后精原细胞肿瘤伴表浅淋巴结与骨髓转移,经化疗后肿瘤消失,患者长期无瘤存活.结论性腺外生殖细胞肿瘤临床少见,较难早期确诊,治疗以化疗与手术相结合,预后与病理类型及部位相关.     

Bilateral malignant testicular germ cell cancer

Twenty-six of approximately 1300 patients (1.9%) with unilateral testicular cancer developed a second primary germ cell cancer (seminoma 18; non-seminoma 8). Patients with previous seminoma had a significantly higher risk of developing a new seminoma than those with a previous non-seminoma. The diagnosis of second primary was made within 3 years of the first diagnosis in only 50% of the patients. In patients with a history of undescended and/or atrophic testes the interval significantly decreased between the diagnosis of the two testicular cancers. The prognosis of bilateral testicular cancer is generally good. Patients in whom the second testicular cancer is at clinical stage I (no metastases) at diagnosis can safely be observed without further treatment after orchiectomy. A patient with unilateral testicular cancer should be informed of the increased risk of developing a second primary germ cell tumour and should be encouraged to perform regular examination of the remaining testis. The need for life-long follow-up visits for patients with testicular cancer is questionable.     

Seminoma associated with bilateral cryptorchidism in Down's syndrome: A case report

BACKGROUND: A case of testicular typical seminoma associated with bilateral undescended testes in Down's syndrome is reported. A 42-year-old institutionalized male patient developed left testicular seminoma with retroperitoneal metastasis. METHODS/RESULTS: Neither adjuvant chemotherapy nor radiotherapy were performed due to his severe mental retardation. He died as a result of the cancer 2 years after a left radical orchiectomy and an autopsy was carried out. DISCUSSION: Recently an increase in the incidence of the association of testicular tumors and Down's syndrome has been repeatedly documented. Thirty-six cases of testicular tumors associated with Down's syndrome have been reported and of these 17.1% had cryptorchidism. This is a much lower percentage considering the high risk of cryptorchidism in males with Down's syndrome. The relationship between testicular germ cell tumors associated with cryptorchidism and Down's syndrome is discussed.     

Clinical statistics of stage I testicular tumor]

PURPOSE: A survey of stage I testicular tumors in the Chugoku-Shikoku district was taken in order to explore the clinical characteristics. PATIENTS AND METHODS: Three hundred and forty eight cases of stage I testicular tumor treated at 46 facilities in the Chugoku-Shikoku district between 1984 and 1992 were collected. Subjects' background factors, treatment methods and prognosis were studied. RESULTS: Tissue types were 249 (71.6%) seminoma and 99 (28.4%) non-seminoma. Adjuvant therapy for seminoma cases included 138 post-operative radiotherapy (4 recurrences, 3 cancer deaths), 57 chemotherapy (no recurrences, 2 contralateral testis tumor cases) and 48 were under surveillance (no recurrence). Adjuvant therapy for non-seminoma cases included 47 chemotherapy (1 recurrence) and retroperitoneal lymph node dissection was performed on 6 cases. Forty cases were under surveillance (1 recurrence). Of 8 (2.3%) cases with recurrence, 6 showed onset within two years and 2 after two years. Four of the 8 cases with recurrence were seminoma (1.1% of seminoma cases) and the other 4 were non-seminoma (4.0% of non-seminoma cases). All 3 (0.9% of all cases) of the cancer death cases were seminoma that received post-operative radiotherapy, while there were no cancer deaths in non-seminoma cases. CONCLUSION: Prognosis of stage I testicular tumor is good. Although the recurrence rate was higher in non-seminoma cases, cancer deaths were only observed in seminoma cases.     

双侧睾丸生精小管内精原细胞瘤的诊断和治疗(附1例报告及文献复习)

目的:探讨睾丸生精小管内精原细胞瘤的诊断和治疗。方法:应用睾丸组织活检和病理检查的方法诊断1例双侧睾丸生精小管内精原细胞瘤患者,附睾内获取精子行卵细胞胞质内单精子注射(ICSI),受孕成功后再行双侧睾丸局部放射治疗。结果:睾丸活检病理结果为双侧睾丸生精小管内精原细胞瘤,附睾内获取液中可见大量发育正常的精子,行ICSI失败1次,再次行ICSI,已成功受孕,行双侧睾丸局部60Co放射治疗,双侧睾丸未见肿物生长。结论:睾丸生精小管内精原细胞瘤是生殖细胞瘤的一种类型,无临床症状,多在睾丸活检时发现,早期治疗预后较好,临床医师和病理科医师应给予重视。     

Testicular seminoma occurring 8 years after treatment of a metastatic extragonadal germ cell tumor

A 30-year-old man was admitted with a chief complaint of left-sided scrotal enlargement, and was diagnosed as having testicular seminoma after orchiectomy. Eight years earlier, he had been treated with chemotherapy for an extragonadal germ cell tumor, without orchiectomy, leading to complete remission. His histological diagnosis at that time was a germ cell tumor, composed of choriocarcinoma and embryonal carcinoma. He was followed up without testicular biopsy. Routine pretreatment testicular biopsy in patients with extragonadal germ cell tumor is controversial, but regular long-term follow up and information on the risk of developing a metachronous testicular tumor are needed after treatment of extragonadal germ cell tumors, even when there seems to be a partial or complete clinical response.     

Ultrasonic localization of a non-palpable testis tumor

A young man was found to have a retroperitoneal seminoma and normal testicles by palpation. Initial diagnosis was an extratesticular primary germ cell tumor until ultrasound examination detected a lesion in the left testicle. A left radical orchiectomy was done and a seminoma of the testicle was found. We recommend ultrasound examination of the testicles to demonstrate occult testicular tumors when faced with the possibility of an extratesticular primary germ cell tumor.     

超声检查在睾丸肿瘤诊断与鉴别诊断中的价值初探

目的:探讨超声检查在睾丸肿瘤诊断与鉴别诊断中的价值。方法:对我院1998～2005年172例睾丸肿块的超声图像结合其手术及病理结果进行回顾性分析。结果:172例睾丸肿块中超声诊断50例睾丸血肿,13例睾丸囊肿,26例睾丸炎性结节,25例睾丸结核,58例睾丸肿瘤;睾丸肿瘤中50例为生殖细胞瘤,其中精原细胞瘤41例,非精原细胞性生殖细胞瘤(NSGCT)9例;6例为非生殖细胞瘤;3例为继发性肿瘤。超声检查发现典型精原细胞瘤、畸胎瘤、表皮样囊肿、间质细胞瘤及多发性的恶性淋巴瘤具有较为特征性的声像图。结论:超声检查可以对睾丸肿瘤作出初步的诊断和鉴别诊断,为进一步治疗方案的制定提供依据,是睾丸肿瘤的首选影像学检查方法。     

腹腔内隐睾恶变3例报告

目的 探讨腹腔内隐睾恶变为巨大精原细胞瘤的临床特点.方法 回顾性分析2007年6月至2011年1月我院收治的3例腹腔内隐睾恶变为巨大精原细胞瘤患者的临床资料及诊治方法,并复习相关文献.结果 3例患者的平均年龄为32.3岁,均表现为隐睾、腹痛及盆腔内肿块.3例最终均行手术治疗,术后病理类型均为精原细胞瘤.术后1个月开始给予放疗或化疗.随访0.5至5年,例1术后5年,健在,性功能正常,未生育;例2术后4.5年,健在;例3术后0.5年,健存.结论 腹腔精原细胞瘤大多继发于隐睾,隐睾患者腹盆腔有增大的肿块应高度怀疑隐睾恶变,手术切除加放化疗较理想.隐睾患者需早期诊断、治疗及长期随访.