Testicular tumors

Germ cell tumors of the testes represent a unique paradigm of diseases which can be cured even in extremely advanced phase. Unfortunately, this makes them unique among adult solid tumors. Seminoma and non seminoma are relatively rare with approximatively 25,000 patients in Europe per year, but numbers are increasing world wide. Different strategies are needed depending on stage and prognostic scores. Seminoma is extremely sensitive to radiation therapy and chemotherapy, while all germ cell tumors show a very good response to chemotherapy. Clinical stage I seminoma is currently treated with radiation, single course carboplatin or surveillance policy. Clinical stage I non seminoma can also be approached with different strategies such as retroperitoneal lymph node dissection, observation or one-two courses of standard chemotherapy. Stage II seminoma may be treated with either radiation or chemotherapy, while for all advanced stages chemotherapy is mandatory. Since the mid-eighties PEB (Cisplatin, Etoposide and Bleomycin) is the regimen of choice and no other schedule has proved superior in terms of efficacy. Surgery on the residual disease is crucial to the whole strategy and should be performed or attempted in all cases. Consequently, the correct treatment strategy for these tumors does not depend only on the ability of a single physician, but on a skilled team specialized in this particular tumor. Second line therapies (VeIP, PEI, TIP) can cure 25%–40% of patients, but improved strategies for resistant tumors are desperately needed. High-dose chemotherapy has shown very good results in some studies while being less impressive in others. In any case, it should remain an option for relapsing patients and could be used in some cases of upfront chemotherapy in patients with slow marker decline, but this should only be considered in referring centers.     

氯丙嗪和氯氮平对小鼠生殖细胞和人淋巴细胞的诱变效应

为探讨氯丙嗪和氯氮平在使用临床治疗剂量时的遗传毒理效应，研究了两药对小鼠生殖细胞和小鼠子代体细胞的影响，以及对人体淋巴细胞姊妹染色单体互换（ＳＣＥ）频率及微核率的影响。结果显示：（１）连续给药５天后第１周两药高、中、低三个剂量组均能引起小鼠精子头部畸形率明显增高，但停药４周后对精子的致畸作用基本消失；（２）两药对小鼠睾丸细胞及子代体细胞的染色体结构畸变率均无明显影响；（３）两药在治疗剂量时对人淋巴细胞的ＳＣＥ频率及微核率无明显影响，治疗前后的自身对照研究亦未见两频率有明显改变；（４）两药的血药浓度与ＳＣＥ频率及微核率之间无量效关系。研究结果提示，两药在临床治疗剂量时对小鼠生殖细胞染色体结构以及对人体遗传物质均无明显损伤作用。     

小鼠腹腔感染中白色念珠菌芽管及蛋白酶活性与其毒力的相关性研究

目的 :探讨白色念珠菌与腹膜炎发生相关的毒力因子。方法 :40株临床分离菌分别以腹腔接种方式感染小鼠进行毒力试验 ,以血清中丙氨酸氨基转移酶 (ALT)和α -淀粉酶 (AM)活力为表示菌株毒力的指标。结果 :白念菌体外测得的芽管长度分别与受染动物血清中ALT、AM含量呈正相关 (rALT=0 . 893,rAM=0 . 80 1,P <0 . 0 1) ,菌株分泌型天冬氨酸蛋白酶 (SAP)活力与血中ALT、AM水平也存在显著的正相关关系 (P <0 .0 1) ,且经SAP特异抑制剂处理过的受染小鼠其ALT活性显著降低 (P <0 . 0 1)。结论 :白念菌芽管和蛋白酶均为其与腹膜炎发生有关的重要的毒力因子     

信号核素134Cs诱发体细胞和生殖细胞畸变效应比较研究

对１３４Ｃｓ诱发体细胞和生殖细胞的畸变效应进行了比较研究。方法观察内污染不同放射性活度１３４Ｃｓ时诱发同体骨髓细胞和精原细胞染色体畸变的量效关系，以及同一放射性活度１３４Ｃｓ作用不同时间诱发上述两种细胞的染色体畸变产额。结果研究发现，１３４Ｃｓ内照射诱发的骨髓细胞染色体畸变产额显著高于精原细胞，而其诱发的染色体畸变类型均以染色单体型畸变为主。结论由不同放射性活度１３４Ｃｓ所诱发的染色体畸变产额而言，骨髓细胞要比精原细胞高出１．５～５倍。     

Histological and morphometric studies on the kinetics of germ cells and immature Sertoli cells during human prespermatogenesis.

Human prespermatogenesis between the 8th week of pregnancy and six months after birth was studied in testis material of 28 male foetuses from spontaneous abortions and 81 infants who died from sudden infant death. The foetuses and infants were grouped in 10 age groups. A first steep raise in the numbers of germ cells per 20 tubular cross sections from 22.3 in the first group up to 69.5 in group 3 was observed, i.e. up to the end of the 22nd week of pregnancy. Thereafter, a continuous decrease could be observed modulated by a second slighter increase during the first 4 months after birth. The ratio of germ cells and immature Sertoli cells improves from about 1:20 at the beginning to 1:8 in group 3; afterwards it changes in favour of the immature Sertoli cells down to 1:140 at the end of the study. The initial augmentation of germ cells is interpreted as the effect of a first proliferation wave comparable to that of M-prospermatogonia in other species. The decrease of germ cells is due to the stop of germ cell proliferation and simultaneous high proliferative activity of the immature Sertoli cells.     

Fine-needle aspiration cytology of an endometrioid-like variant of yolk sac tumor.

A 36-year-old male with a history of immature teratoma and embryonal carcinoma of the testis was admitted to the hospital for abdominal pain and fever. A CT scan revealed a large right abdominal mass. The patient's serum alpha-fetoprotein (AFP) was 46.8 ng/ml (reference < 25 ng/ml). Fine-needle aspiration (FNA) of the mass revealed malignant glandular cells. Chemotherapy was instituted, followed by resection of the large abdominal mass. The tumor was grossly encapsulated, consisting of large areas of necrotic, hemorrhagic tissue surrounded by smaller, multiloculated cysts. Microscopically, the tumor had a villoglandular pattern and variably stratified tall columnar cells. A prominent feature of the columnar cells was supranuclear and subnuclear vacuolization. Intracytoplasmic PAS-positive, diastase-resistant hyaline globules were occasionally present. AFP by immunoperoxidase was prominent within the tumor. This recurrence of the previously diagnosed testicular teratoma with embryonal carcinoma represents a yolk sac tumor with components strongly resembling endometrioid carcinoma, a variant only recently described in eight cases of ovarian origin (Clement et al.: Am J Surg Pathol 1987; 11(10):767-778). We believe this is the first reported case of an endometrioid-like variant of testicular yolk sac tumor and also the first report of the FNA cytology findings in this variant.     

人绒毛膜促性腺激素在脑实质生殖细胞肿瘤诊治中的意义

目的研究脑实质生殖细胞肿瘤(GCT)患者脑脊液和血清中人绒毛膜促性腺激素(HCG)水平变化,评价其在肿瘤诊断、疗效监测中的意义。方法对5例脑实质内GCT患者的脑脊液和血清HCG水平在治疗前后进行系列测定。以10例性别年龄匹配的因其他疾病接受腰穿检查的患者作为对照组,测定其脑脊液HCG水平。观察脑脊液和血清HCG水平在治疗前后的变化情况。结果10例对照组患者的脑脊液中均测不到HCG。从5例GCT患者共采集17对脑脊液和血清配对样本。所有5例患者都出现脑脊液和血清HCG水平升高。治疗后脑脊液和血清HCG水平迅速下降。血清和脑脊液HCG水平呈显著相关。每一对样本中,脑脊液HCG水平均高于血清。血清、脑脊液HCG水平比为0.245±0.190。结论脑脊液HCG升高对诊断脑实质内GCT具有高度特异性和较高灵敏度。对分泌HCG的GCT,脑脊液和血清HCG是评价治疗效果和监测肿瘤复发的重要指标。