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。     

腹部隐睾精原细胞瘤的CT诊断

目的：探讨腹部隐睾精原细胞瘤的CT特点,以提高对本病在腹部肿瘤中的诊断。方法：总结分析经手术病理证实的7例精原细胞瘤,对其影像表现进行回顾性分析。结果：4例表现为单侧腹部肿块,内见不规则小片状低密度坏死灶,肿块长轴与睾丸下行路径一致,3例较大肿块跨越脊柱前方位于腹膜后。结论：隐睾精原细胞瘤的CT征象具有相对的特征性,密切结合临床综合分析,对于本病的诊断有重要价值。     

Isolated late metastasis from testicular seminoma presenting as a parotid gland mass: case report and review of the literature

Parotid metastases from non–head-and-neck cancers are rare and may represent a diagnostic and therapeutic challenge. A late metastasis to the parotid gland from a seminoma is an unusual manifestation of disease. A 45-year-old man with a history of testicular seminoma 5 years earlier presented with a rapidly progressing parotid mass. Ultrasonography and computed tomography showed a space-occupying lesion at the angle of the right jaw. The mass was infiltrating into the parotid gland and into the parapharyngeal space. A primary parotid neoplasm was suspected, and panendoscopy combined with open biopsy was performed. Histology examination confirmed a seminoma metastatic to the parotid gland, and comparison with the primary tumour showed identical histology. The patient received chemotherapy for recurrent seminoma in accordance with the pei (cisplatin, etoposide, ifosfamide) protocol. After 4 courses of chemotherapy, salvage radical parotidectomy with removal of all suspicious residual tumour tissue was performed.This case illustrates the difficulties that may be encountered in the differential diagnosis of parotid gland masses and underlines the necessity for a detailed clinical history and for strong interdisciplinary collaboration between oncologists and pathologists to correctly diagnose cases with such unusual presentations.     

睾丸精原细胞瘤的MRI表现

目的探讨睾丸精原细胞瘤的MRI表现。方法回顾性分析3例腹内型隐睾合并精原细胞瘤和6例阴囊内睾丸精原细胞瘤MRI表现。结果隐睾合并的精原细胞瘤MRI表现为类圆形较大的等-长T1长T2信号,内部有坏死及囊性变,线状纤维血管间隔T1WI、T2WI显示清楚;增强后肿瘤缓慢轻度强化,纤维血管间隔早期线样强化。阴囊内睾丸精原细胞瘤平扫MRI表现为小结节状,T2WI呈低信号,内见较厚的低信号纤维血管分隔,增强后边缘及内部纤维血管间隔早期呈蚓状强化,肿瘤实质成分缓慢轻度强化。结论腹内型隐睾合并精原细胞瘤与阴囊内精原细胞瘤的纤维血管间隔早期显著强化是精原细胞瘤的共同特征,但二者大小、形态、边缘表现不同,增强后边缘及内部纤维血管间隔强化形态不同。     

改良根治睾丸切除术治疗Ⅰ期睾丸精原细胞瘤

目的　探讨改良睾丸根治性切除术治疗Ⅰ期精原细胞瘤安全性、有效性。 方法　回顾性分析2009年1月~2012年8月我院收治的28例Ⅰ期睾丸精原细胞瘤患者的临床资料,13例患者采用改良根治性睾丸切除术,15例患者采用传统经腹股沟根治性睾丸切除术。比较两组患者的年龄、手术时间、切口长度、术后疼痛评分、术后平均住院时间、并发症发生率、术后复发率。 结果　改良根治组和传统根治组两种手术方式手术均获得成功,在手术时间、并发症发生率及术后复发率方面两种手术方式无明显著异（P>0.05）,但两组术后疼痛评分、切口长度、术后平均住院时间方面有显著差异（P<0.05）,且改良根治组因切口比传统根治组小,更具美观效果。 结论　改良根治性睾丸切除治疗Ⅰ期精原细胞瘤是安全的,有效的,与经腹股沟根治性睾丸切除术相比,具有切口微创美观、术后疼痛轻、恢复快的特点。     

睾丸精原细胞瘤的彩色多普勒超声表现及其诊断价值

目的探讨睾丸精原细胞瘤的彩色多普勒超声表现及其诊断价值。方法回顾性分析经病理证实的23例睾丸精原细胞瘤的二维声像图,彩色多普勒及脉冲多普勒频谱特征。结果在23例睾丸精原细胞瘤中,外生肿块型8例,内生肿块型11例,弥漫浸润型4例。本组睾丸精原细胞瘤超声表现共同特征是：显示患侧睾丸增大,内部可见实质性回声团,彩色多普勒超声显示睾丸精原细胞瘤内部及周边血流信号丰富、杂乱、动脉血流频谱,收缩期最大峰值流速（PSV）为11～23 cm/s,阻力指数（RI）为0.34～0.57。结论彩色多普勒超声在诊断睾丸精原细胞瘤中起重要作用,应作为诊断本病的主要方法。     

Gastric adenocarcinoma with features of endodermal sinus tumor

Extragonadal germ cell tumors are rare. The most common sites for EGGCTs are in midline locations such as the mediastinum, retroperitoneum and pineal gland.These tumors rarely present in the stomach. We describe here a case where a middle aged man presented with typical symptoms of gastric cancer. After extensive workup, which included blood work, CT abdomen scan,upper endoscopy, and endoscopic ultrasound, the patient was diagnosed with gastric cancer. However,due to very high blood levels of alpha-fetoprotein, the specimen was sent for special histochemical staining,which demonstrated that the tumor had features of both adenocarcinoma and endodermal sinus tumor. This is a very aggressive tumor with a very poor prognosis.     

Ⅱ期睾丸精原细胞瘤的临床研究

目的探讨手术及化疗在Ⅱ期睾丸精原细胞瘤治疗中的作用。方法1993年2月～2007年8月收治Ⅱ期睾丸精原细胞瘤44例,采用以顺铂为基础的多疗程化疗,4例化疗前行腹膜后淋巴结廓清术,10例在化疗后行腹膜后淋巴结廓清术。结果8例化疗后廓清组织为坏死及纤维化组织,2例为恶性肿瘤。连续随访2～8年,5年生存率Ⅱa期100%（11/11）、Ⅱb期91.67%（22/24）、Ⅱc期77.78%（7/9）。结论Ⅱ期睾丸精原细胞瘤应尽早采用多疗程化疗控制病期进展达到有效治疗,最终提高其生存率。     

Tumor development in three patients with Noonan syndrome

The diagnosis of Noonan syndrome is essentially clinical, based upon the distinct phenotype and the involvement of the cardiovascular system. Tumor development is a rare manifestation of Noonan syndrome but can be explained by the molecular pathophysiology involved in the disorder. We present three Noonan patients who developed solid tumors. The first patient, a 4-year-old girl, developed granular cell tumors as did her mother in childhood. The second patient, a 1-year-old boy, had a low grade pilocytic astrocytoma, the clinical expression of which was persistent headache. MRI showed a pituitary mass in the posterior lobe. It was surgically removed. The third patient, a 7-year-old boy was found to have Sertoli tumors in his right cryptorchid testis. All three patients fulfilled the clinical criteria for Noonan syndrome. However, genetic testing was negative in patients 1 and 3. The diagnosis of Noonan syndrome was made based on distinct phenotypic findings in three patients who had different types of tumors.     

睾丸精原细胞瘤的MSCT诊断

目的:探讨睾丸精原细胞瘤的MSCT影像特点。方法:回顾性分析有完整CT平扫及增强资料、经病理证实的9例睾丸精原细胞瘤的MSCT表现。结果:9例中5例为腹部隐睾肿瘤、4例为阴囊上方肿瘤。主要CT表现为:肿瘤有完整或不完整包膜,增强后有8例呈轻~中度分隔样强化,腹部5例腹股沟管内精索缺失,4例阴囊上方肿瘤,精索伴行血管增粗,血管成像显示5例腹部及3例阴囊内肿瘤显示为同侧睾丸动脉供血。伴同侧肾脏、精索及精囊腺缺如1例,伴两侧输尿管下端囊肿1例,伴子宫样结构(假二性体)1例,睾丸下降固定术后两年恶变1例。结论:睾丸精原细胞瘤有一定影像学特征性,结合MSCT血管成像所示睾丸动脉供血及伴随泌尿生殖系其它发育异常可作出定性诊断。