多层螺旋CT血管成像对腹部隐睾肿瘤的诊断价值

目的 探讨多层螺旋CT（MSCT）血管成像对腹部隐睾肿瘤血管的显示及诊断价值。方法 回顾性分析经手术病理证实的5例腹部隐睾精原细胞瘤及其肿瘤血管的MSCT表现。结果 （1）5例肿瘤供血动脉均为同侧睾丸动脉，该动脉迂曲、增粗，于肿瘤后外方进入并终止于肿瘤。（2）肿瘤体积均较大，有完整包膜者2例，包膜不完整者3例，3例肿瘤密度不均匀，有坏死，肿瘤血供较丰富而肿瘤实体部分强化约14～25HU。结论 MSCT血管成像很好地显示了肿瘤供血动脉及瘤内血管分布情况，根据肿瘤由睾丸动脉供血可以作出腹部隐睾肿瘤的定性诊断。     

Profiles of epitope-defined markers in sera from patients with testicular germ cell tumors

Summary Epitope-defined tumor markers of AFP (FA), HCG (PM), PLAP (H7) and CEA (D/AH) were determined by monoclonal antibodies in sera of patients with germ cell tumors of the testis. Characteristic profiles of PLAP (H7) were seen in localized and metastatic seminoma and in sera of patients with mixed tumors with seminoma components. PLAP (H7) levels started to rise 10 months before clinical detection of recurrence in one case. Persisting elevated levels of PLAP (H7) in several cases were indicative of metastafic seminoma. PLAP (H7) occurred rarely in sera of patients with metastasing non-seminomatous tumors. AFP (FA) detected in seminoma sera led to identification of non-seminomatous disease in one case. High AFP (FA) alone occurred in yolk sac tumors, HCG (PM) with AFP (FA) or PLAP (H7) in patients where the tumors had components of teratoma and/orembryonal carcinoma, moderately elevated levels of AFP (FA) and sometimes also HCG (PM) occurred.     

Patterns of care outcome studies: Results of the national practice in seminoma of the testis

The national practice in managing seminoma of the testis has been determined for 1973. Recurrence-free survival at four years is: Stage I, 97%; Stage II, 97%; and Stage III, 70%. A special group called Stage I-C, who had no evaluation of their retroperitoneal lymph nodes, exhibits a significantly worse survival (87%). Complications are uncommon (2%) and most could be avoided by using appropriate radiation doses and treatment techniques. Excessive radiation doses are used in patients with Stage I seminoma, 54% of them receiving more than 3000 rad.     

Evidence of interepithelial seminoma spread into the rete testis by immunostaining of paraffin sections with antibodies against cytokeratin and vimentin

Summary Seminomas are tumors of high proliferative activity and show a marked tendency towards local invasion with the capacity for interepithelial spread within the seminiferous tubules as well as into the rete ductules. Immunohistologic investigations were carried out on paraffin sections of 47 typical seminomas. Immunostaining with antibodies against cytokeratin and vimentin allows the convenient detection of even small rete residuals in cases of subtotal rete destruction as well as the identification of discrete interepithelial seminoma spread within the rete ductules, thus facilitating seminoma staging.     

TNM staging of testis cancer

Of one-thousand patients with testicular cancer treated mainly at the Memorial Sloan-Kettering Cancer Center from 1949 to 1974, 304 patients with pure seminoma and 659 patients with either embryonal carcinoma (329), teratocarcinoma (310) or pure choriocarcinoma (20), were staged clinicopathologically according to the TNM Classification. Paratesticular structures were involved (T_2–4) in 7% of all germinomas; para-aortic lymph nodes (N_1–3) in 15% of seminomas and 31 % of carcinomas; juxtaregional lymph nodes (N₄) in 6% of seminomas and 8% of carcinomas; and distant organs (M₁) in 4% of seminomas and 23% of carcinomas. Five year survivals were 80% in T₁ and 77% in t_2–4 pure seminomas, and 46% in T₁ and 34% in T_2–4 germinal carcinomas. The 5-year survival rates in pure seminoma versus germinal carcinomas, were 88% versus 76% in N₀M₀ 64% versus 36% in N_1–3, 53% versus 30% in N₄, and 27% versus 11% in M₁ tumors. Cancer recurrence in 5 or more years was 28% in T₁ and 18% in T_2–4 pure semnomas, and 58% in T₁ and 70% in T_2–4 germinal carcinomas. The recurrence rates in pure seminoma versus germinal carcinomas, were 17% versus 29% in N₀M₀ 55% versus 67% in N_1–3, 53% versus 74% in N₄, and identically 91% in M₁ tumors.     

Testicular tumors: Oncologic imaging and diagnosis

The extreme radiosensitivity of testicular seminomas plus recent advances in chemotherapy for nonseminomatous tumors and for advanced seminomas have made long term survival possible in the large majority of patients with testis cancer. Since choice of therapy is determined by tumor histology and extent of disease, accurate clinical staging is critical. Computed tomography (CT) of the abdomen and chest is the imaging procedure of choice for staging testis cancer. Clinical staging accuracy of 80 to 90% can be achieved using CT in combination with radioimmunoassays for β-HCG and AFP. Ultrasonography (US), while less sensitive and specific than CT for determining nodal status, may be useful in thin patients with sparse retroperitoneal fat; in addition US may play an important role in detecting occult testicular neoplasms and in assessing primary tumor extent within the scrotum. Lymphangiography should be reserved for Stage I patients in whom elective treatment of the retroperitoneum is not planned. Follow-up should include serial radioimmunoassays for serum AFP and β-HCG and periodic CT examinations of the abdomen and chest. Technical improvements in CT scanners and further experience with the use of tumor markers should help refine our ability to stage and manage patients with testicular tumors. In addition, nuclear magnetic resonance (NMR) imaging and radionuclide imaging following injection of radioactively labelled antibodies to AFP and β-HCG are new techniques which offer great promise for the future.     

Radiation therapy of seminoma of the testis

Seventy-three consecutive patients with seminom of the testis were treated by orcbiectomy followed by radiation alone. Sixty-six patients (9196) survived for more than five years. Forty-nine of fifty-six (87 %) survived for more than tan years. The five-year survival for 54 patients with Stage I disease was 100 % ; it was 92 % for 13 patients with Stage II disease. None of the six Stage III patients smviv All those who survived for five years were leading an active and normal life as of this writing. The Karoofsky's performance status was 90–100 for 50 patients who were followed is detail. Routine postoperative irradiation of the pare-aortic lymphatics was sufficient to produce a permanent cure without resorting to chemotherapy or prophylactic irradiation of mediastinum and supraclavicular regions. The optimal tissue does was 3000 rad. It may be increased to 3500–4000 rod by reducing the portal, but the total dose should be kept under 4000 rad. Pulmonary metastases were treated by bilateral whole hog irradiation of 1000–1500 rad followed by a coal boost dose of 2000–2500 rad. The treatment was well-tolerated by the patient. Large intra-abdominal metastases involving the internal organs should be treated by means other than radiation alone.     

Infundibular germinoma

Summary Five cases of germinoma occurring in the infundibular region are presented. The clinical symptoms and treatment as well as the cytological and histological pictures, including the ultrastructural findings, are described. When unassociated with other neoplastic germ cell elements, infundibular germinoma is considered to be a highly radiosensitive tumour with a good prognosis.     

Postchemotherapy Surgery for Germ Cell Tumors—What Have We Learned in 35 Years?

Postchemotherapy surgery for advanced testicular cancer has evolved over the last couple of decades. Patients with nonseminomatous germ cell tumors and residual retroperitoneal mass ≥1 cm should undergo postchemotherapy retroperitoneal lymph node dissection (RPLND). For seminoma, RPLND is considered in those patients with masses ≥3 cm that are also positron emission tomography positive. Masses that occur outside of the retroperitoneum should be completely resected with the possible exception of bilateral lung masses when resection of the first mass shows necrosis. The role of surgery in patients with extragonadal germ cell tumors is most vital in those with primary mediastinal nonseminomatous germ cell tumors. Importantly, patient selection, surgical planning, and consideration of referral to centers with this expertise are important to optimize success.     

睾丸精原细胞瘤的CT、MRI诊断(附6例分析)

目的:分析睾丸精原细胞瘤的CT、MRI表现以提高对该病的认识.方法:对经手术病理证实的的6例睾丸精原细胞瘤CT、MRI表现进行回顾性分析.2例患者行CT检查,2例行MRI检查,2例同时行CT和MRI检查.结果:精原细胞瘤CT主要表现为密度相对均匀,增强后肿瘤轻至中度强化.MRI主要表现为多结节状或分叶状,信号均匀,T2W1显示更低信号条带状样分隔,增强时分隔强化.结论:睾丸精原细胞瘤影像学表现有一定特征性,尤其MRI检查对病变诊断具有重要意义.