新生儿睾丸畸胎瘤3例报告并文献分析

目的：探讨新生儿睾丸畸胎瘤的临床特点和诊治方法。方法：回顾性分析3例新生儿睾丸畸胎瘤的临床资料及随访情况,结合近年国内外新生儿睾丸畸胎瘤的相关文献进行讨论。结果：3例睾丸畸胎瘤患儿均采用睾丸根治性切除术,术后随访6～24个月,均无复发、转移,无瘤生存率为100％。结论：新生儿睾丸肿瘤以畸胎瘤多见,且多为成熟型。治疗上可行睾丸根治性切除术,一般不需辅以放疗或化疗。预后良好。     

64例儿童睾丸畸胎瘤病例分析

目的:分析儿童睾丸畸胎瘤的诊断与治疗,旨在提高其临床诊治水平。方法:回顾性分析本院1995~2014年收治的64例儿童睾丸畸胎瘤的临床资料。结果:61例以无痛性阴囊包块就诊,查体均有沉重感;3例因阴囊空虚诊断为隐睾时发现。术前46例甲胎蛋白(AFP)明显升高,18例AFP值正常。超声检查提示异常混杂回声区,内有钙化成分或液化坏死。阴囊X片检查28例有点片状、弧形高密度影。40例于我院行睾丸肿瘤剜除术(TSS),1例院外手术,20例行高位瘤睾切除术,3例放弃手术治疗。病理检查成熟畸胎瘤均可见成熟的3个胚层,未成熟畸胎瘤可见原始神经管等未成熟胚层成分。60例手术患儿中11例为不成熟畸胎瘤,49例成熟畸胎瘤。成熟畸胎瘤术后无需化疗,未成熟畸胎瘤术后采用顺铂+依托泊苷+博来霉素(Cisplatin,Etoposide,Bleomycin,PEB)方案化疗。随访2年均未见复发或转移。结论:儿童睾丸畸胎瘤多因无痛性阴囊包块就诊,查体包块有沉重感;AFP多有异常,超声及阴囊平片对诊断有一定帮助。手术方案主要为TSS,术中冰冻能协助术者选择手术范围。成熟畸胎瘤术后无需化疗,未成熟畸胎瘤术后应配合化疗。     

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。     

成人睾丸良性占位病变的诊断与治疗选择(附16例报告)

目的 探讨成人睾丸良性占位病变的诊断与治疗选择.方法 对2003～2010年诊治的16例睾丸良性肿瘤的临床资料及随访情况进行回顾性分析.结果 16例睾丸肿瘤病例术前经超声、CT或MRI、AFP和β- HCG检查,诊断13例考虑为良性病变,3例可疑恶性.术中行冰冻切片检查10例,其中7例行睾丸部分切除术,3例性质不定行睾丸根治性切除术.6例未行术中病理检查直接行根治性睾丸切除.术后经病理诊断睾丸间质细胞瘤2例,成熟畸胎瘤4例,腺瘤样瘤3例,平滑肌瘤3例,皮样囊肿1例,混合肿瘤3例.术后随访2个月～12年均未出现复发及转移.结论 睾丸良性占位的术前诊断对手术处理方式选择非常重要,B超、CT或MRI、肿瘤标记物以及术中冰冻切片活检均具有临床诊断价值.睾丸良性肿瘤的治疗应首选保留睾丸的肿瘤切除.     

成人睾丸畸胎瘤的诊治体会

目的探讨成人睾丸畸胎瘤的临床特点、诊治方法及预后。方法回顾性分析我院2014年6月至2016年6月收治的3例成人睾丸畸胎瘤患者的临床资料,年龄22~28岁,平均24岁。术前阴囊彩色多普勒超声检查示睾丸肿瘤直径1.6~10.0cm,平均5.6cm。3例腹盆腔CT检查均未见异常。3例睾酮水平、精液指标均正常,2例肿瘤标记物AFP、β-hCG均正常,1例升高。1例行保留睾丸的肿瘤切除术;2例行根治性睾丸切除术。结果 3例手术均顺利完成,手术时间45~80min,平均62min。术后病理诊断1例为皮样囊肿,1例为成熟性畸胎瘤,1例为伴有体细胞恶性成分的畸胎瘤。2例术后接受化疗。术后随访12~36个月,平均21个月,3例均存活;3例术后睾酮水平、AFP、β-h CG、精液指标均正常;2例未见肿瘤复发和转移,1例术后6月AFP、β-h CG升高,发现腹膜后肿瘤复发。结论成人睾丸畸胎瘤临床少见,睾丸皮样囊肿则为罕见。青春期后型睾丸畸胎瘤有恶性行为,应尽早行睾丸根治性切除术,青春期前型可选择保留睾丸的手术。成人睾丸畸胎瘤的预后取决于肿瘤组织类型和病理分期。     

小儿原发性睾丸肿瘤的诊断和治疗

目的 提高小儿睾丸肿瘤的临床诊断和治疗水平.方法 回访近6年27例小儿原发性睾丸肿瘤患者,平均年龄41.3个月(1～150个月),平均病程14个月,其中25例源于生殖细胞,17例为良性畸胎瘤;恶性胎瘤10例,其中6例为卵黄囊瘤,2例为胚胎性癌,非生殖细胞恶性肿瘤2例.结果 所有患儿随访1～6年,良性畸胎瘤患儿均施行保睾手术,预后良好.10例恶性肿瘤行根治性睾丸切除,其中3例辅加单侧腹膜后淋巴结清扫术,4例术后复发,其中3例曾再次手术,术后2例患儿死亡.结论 小儿恶性睾丸肿瘤多为卵黄囊瘤,睾丸良性肿瘤多为畸胎瘤,睾丸肿瘤的发现以及诊断并不困难.对于恶性睾丸肿瘤应采取睾丸切除加高位精索结扎术和腹膜后淋巴清扫术,必要时附加化疗.     

保留睾丸手术治疗良性睾丸肿瘤的临床应用

目的:探讨保留睾丸手术治疗成人睾丸肿瘤的安全性和可行性。方法:分析我院2005年10月至2012年3月间手术治疗的8例睾丸肿瘤患者的临床资料。结果:8例患者年龄18~67岁,平均年龄45岁,术前检查后,考虑为良性病变。8例患者成功实施睾丸部分切除术,术中均行快速病理确认手术切缘阴性。术后经病理检查和免疫组化诊断睾丸支持细胞瘤3例,腺瘤样瘤3例,成熟畸胎瘤2例。8例患者随访6个月~7年,平均4年,均未出现复发及转移;患者手术前后的睾酮水平、IIEF评分、精液常规指标无明显差异。结论:保留睾丸的睾丸部分切除术是治疗睾丸良性肿瘤的有效方法之一。对合适的患者,应仅最大限度保留睾丸组织,不影响患者术后的生活质量。     

特殊临床表现的卵巢成熟型畸胎瘤12例临床分析

目的总结12例具有特殊表现的卵巢成熟型畸胎瘤的临床特点和处理的经验。方法于2003年2月至2013年5月间,北京协和医院共收治卵巢成熟型畸胎瘤手术患者3 688例,其中选取12例罕见临床表现的患者,进行回顾性分析。结果在12例患者中,8例出现月经改变甚至闭经,其中3例有高雄激素血症,1例表现高泌乳素血症和泌乳;3例为抗N-甲基-D-天冬氨酸(NMDA)受体脑炎综合征,主要表现为精神神经系统异常症状,其中大笑、大喊、胡言乱语等精神症状1例,发作性四肢抽搐、意识障碍等神经症状2例;另1例表现为腹痛伴发热,大便中排出油脂、毛发。12例均经手术治疗,术后病理均证实为卵巢成熟型畸胎瘤,未发生死亡及术后并发症;术后症状和体征均明显缓解甚至完全消失;术后随访14~101个月,未再出现肿瘤或症状复发。结论卵巢成熟型畸胎瘤尽管临床表现不典型,但是通过体格检查和影像学辅助检查可得到诊断,并通过手术治疗能达到满意效果。提高对本病的认识,进行妇科及盆腔影像学检查是获得早期诊断、及时治疗,并取得良好预后的关键。     

成人睾丸胚胎癌的诊断和治疗(附3例报告并文献复习)

目的 探讨睾丸胚胎癌的临床症状、病理特点及诊疗方法.方法 回顾性分析3例睾丸胚胎癌的临床资料并总结国内外病理文献.3例中Ⅰ期2例、Ⅲ期1例,于根治性睾丸切除术基础上采用腹膜后淋巴结清扫术及化疗等综合治疗.结果 3例病理诊断均为睾丸胚胎癌,1例术后辅助化疗.3例均获随访,随访时间1～3年,1例死于全身广泛转移,其余2例均健康生存.结论 睾丸胚胎癌是一种少见的恶性肿瘤,多数临床症状不明显.诊断主要依靠阴囊理学诊断,B超、CT、血清肿瘤标记物测定等,确诊需要病理学检查,手术切除是其首选的治疗方法.     

显微镜下睾丸肿瘤剜除术治疗睾丸肿瘤的临床价值

目的探讨在显微镜下剜除睾丸肿瘤并同时保留睾丸正常组织治疗睾丸肿瘤的临床价值。方法选取南京医科大学附属淮安第一医院泌尿外科2010年1月至2017年11月间部分手术治疗的10例睾丸肿瘤患者的临床资料进行分析。结果 10例患者仅1例患者无生育需求;其中2例行睾丸部分切除术,3例行显微镜下睾丸肿瘤剜除术,5例行根治性睾丸切除术。保留睾丸组织术中均行快速病理确认良性肿瘤及手术切缘阴性,术后病理检查诊断示畸胎瘤1例,表皮样囊肿4例,恶性肿瘤5例。术后患者经随访6个月～5年,均未出现复发及转移。结论在保留睾丸正常组织前提下切除睾丸肿瘤对治疗睾丸良性肿瘤具有一定的临床意义,其中显微镜下睾丸肿瘤剜除术可作为治疗睾丸良性肿瘤的优先选择。     

Testicular pure teratoma: a case report

A 46-year-old man visited our hospital, complaining of fever and painful swelling of the right scrotum contents. The symptoms and signs suggested epididymitis, but testicular tumor could not be excluded. Therefore, high inguinal orchiectomy was performed. Macroscopic findings were compatible with the testicular teratoma, containing hair, and epididymitis. Histological findings revealed that the tumor was composed of mature epidermis with skin appendages, cartilage, hair, bone and adipose tissue, and that many leucocytes infiltrated in the epididymis, resulting in the diagnosis of pure mature teratoma with epididymitis. For 6 months after the operation, no evidence of recurrence has been observed. Despite its histologically benign appearance, primary pure teratoma of the testis has a metastatic and recurrent potential. Therefore, primary pure teratoma should be man aged in the same way as other nonseminomatous germ cell tumors.     

Testicular sparing surgery for prepubertal teratoma of the testis: a clinical and pathological study

We report on 5 patients 14 months to 6 1/2 years old with prepubertal teratoma of the testis treated by testicular sparing tumor enucleation. All 5 patients had no evidence of recurrence at a mean followup of 96 months. Recognizing that this is not accepted therapy for testis tumors, 17 orchiectomy specimens containing teratoma from children were histologically analyzed in cooperation with the Armed Forces Institute of Pathology Tumor Registry. All patients were prepubertal at orchiectomy (3 months to 8 years old) and all are well with a mean followup of 174 months. Histological examination revealed no foci of teratoma separate from the main tumor in any specimens. Immunohistochemical studies with placental alkaline phosphatase, a marker for malignant germ cells, were done to detect carcinoma in situ in the seminiferous tubules of these testes. This test did not reveal any intratubular malignant germ cells (carcinoma in situ). Based on our clinical experience with testicular sparing tumor enucleation, the histological findings on Armed Forces Institute of Pathology review demonstrating no associated carcinoma in situ and the universally benign behavior of prepubertal testicular teratomas, we recommend a testicular sparing operation rather than orchiectomy for testicular teratoma in prepubertal patients.     

睾丸肿瘤的诊断

目的 :提高睾丸肿瘤的诊断水平。　方法 :回顾 1 992年 9月～ 2 0 0 1年 1 2月睾丸肿瘤 57例病人的症状、体征 ,影像学、肿瘤标记物和病理资料。　结果 :1 8例病人 (31 .3 % )延迟就医。术前查甲胎蛋白 (AFP) 1 1例 ,5例阳性。检测绒毛膜促性腺激素亚单位 (β HCG) 6例 ,1例阳性。二维B超及彩色多普勒血流显像超声 (CDFI)的灵敏度分别为 93 .5 % (45/ 4 7)、96 .4 % (2 8/ 2 7)。 55例行根治性睾丸切除术 ,2例行单纯睾丸切除术。后腹膜淋巴结清扫术 1 9例 ,淋巴结阳性 1 1例 ,阴性 8例。石蜡切片 57例 ,精原细胞瘤 2 2例 ,胚胎癌 9例 ,畸胎瘤 7例 ,卵黄囊瘤3例 ,混合性生殖细胞瘤 9例 ,恶性淋巴瘤 4例 ,其他 3例。其中 2 6例行术中冰冻切片 ,2 3例 (88.5 % )与石蜡切片报告符合。　结论 :病人需强化健康意识 ,尽早就医 ;术中常规冰冻切片 ,明确良、恶性肿瘤 ,是提高诊断水平 ,避免延误诊治的根本途径     

Late recurrence of mature teratoma in nonseminomatous testicular tumors after PVB chemotherapy and surgery

We present the case histories of 3 patients in whom a growing mature teratoma developed twenty-eight, thirty-one, and thirty-three months after successful remission-induction chemotherapy with cisplatinum, vinblastine, and bleomycin (PVB) for a disseminated nonseminomatous testicular tumor (NSTT). The serum tumor markers were not increased. The teratomas were all localized retroperitoneally, two being found near the site of excision of a residual tumor after remission-induction chemotherapy. Two of the 3 patients were alive without further treatment after excision of the teratoma; the third patient did not die of tumor progression, but mature teratoma was still present. Even if the serum tumor markers are not increased, recurrent tumors in patients previously given PVB chemotherapy because of a disseminated NSTT should be excised to establish their histology. En-bloc excision of the recurrent tumor is sufficient. It is pointed out that a mature teratoma can become a large cystic tumor in the course of time: the so-called growing mature teratoma syndrome. We believe that, after remission-induction chemotherapy of disseminated NSTT with a teratoma component in the primary testicular tumor, any residual tumor should be excised to prevent subsequent tumor progression.     

The Role of Retroperitoneal Lymphadenectomy in Mature Teratoma of the Testis

Purpose

Pure testicular teratoma is rare in adulthood with an incidence of 5%. Pure teratoma is considered less aggressive and less likely to metastasize than other nonseminomatous germ cell tumors. Therefore, patients with mature teratoma have been considered candidates for surveillance protocols. We report our experience with 44 cases of primary pure testicular teratoma.

Materials and Methods

We retrospectively identified 44 patients (5.7%) with primary pure teratoma of the testis of the 772 treated for testicular germ cell tumors at our institutions. Archival tumor blocks were available for pathological reevaluation and serial sections were obtained in all cases. A total of 35 patients (79.5%) who presented with clinical low stage disease, including stage I in 26 (59.1%) and stage IIA/B in 9 (20.4%), underwent radical orchiectomy followed by retroperitoneal lymphadenectomy. Nine patients (20.5%) who presented with clinically advanced disease (stages IIC to IV) were treated with primary chemotherapy and secondary retroperitoneal lymphadenectomy of residual masses.

Results

The frequency of lymph node metastases was 19.2% in clinical stage I disease and 66% in stage IIA/B. Histopathological diagnosis of mature teratoma was confirmed in all cases. However, of 20 patients 16 (80%) had scars or calcifications in the adjacent parenchyma, indicating a burned out tumor, and 4 (20%) had microfocal embryonal carcinoma. None of the patients with clinical stage I disease had relapse during followup and the relapse rate in those with stage IIA/B disease was 33%. Median followup was 97 months (range 24 to 250). Overall 43% of patients with pure teratoma presented with metastatic disease.

Conclusions

Our data demonstrate the malignant potential of pure testicular mature teratoma. Based on our results metastases in testicular mature teratoma seem to result from metastasizing nongerm cell components undergoing early regression, as demonstrated by the high frequency of burned out tumors. We recommend that serial sections be taken of the orchiectomy specimen in all cases of pure mature teratoma to determine adequate management: retroperitoneal lymphadenectomy in cases of associated scars, calcifications or microfocal malignant germ cell components and surveillance in cases of pure mature teratoma.     

Secondary surgery in advanced testicular germ-cell tumors

Twenty-four patients with residual tumor after intensive chemotherapy for advanced testicular germ-cell tumors were subjected to secondary surgery. Twenty patients had complete resection with the following distribution of histological types: 4 embryonal carcinoma, 9 mature teratoma and 7 fibrous tissue. Eighteen of these patients remain free of disease. Four patients had incomplete resection. Two of these patients with embryonal carcinoma died later despite further treatment; 2 patients with teratoma remain free of disease. Secondary surgery is recommended in cases where residual tumor is found after intensive chemotherapy and where tumor markers are not elevated.     

Organ-sparing surgery for contralateral testicular tumor following orchiectomy : a case report

A 30-year-old man underwent a left high orchiectomy because of stage I testicular tumor in December, 2006. A palpable nodule was noticed in the contralateral testicle in March, 2008. No tumor marker was elevated. Imaging studies including ultrasonography and magnetic resonance imaging showed a 13 mm tumor consisting of both a solid portion and a hemorrhagic cyst. A malignant tumor could not be ruled out completely based on examinations and his medical history. Tumor resection with partial orchiectomy was planned after informed consent. Preoperative serum concentration of free testosterone was 8.4 pg/ml, and motile sperm were found in the semen analysis. The tumor was resected while the spermatic cord was clamped transiently. The pathological diagnosis of frozen sections confirmed no malignancy, and the final pathological result was mature teratoma, no evidence of malignancy. No androgen substitution has been required. Furthermore, a few normal motile sperm were detected in the ejaculated semen after the surgery. Organ-sparing surgery for the contralateral testicular tumor following orchiectomy, can be considered to avoid infertility and hormonal substitutions.     

肾上腺畸胎瘤1例报告并文献复习

目的探讨肾上腺畸胎瘤的临床特点。方法分析我院收治的1例肾上腺畸胎瘤患者的临床资料及诊治方法,并复习国内外相关文献。结果患者为45岁女性,右腰背隐痛3 d就诊;B 超示肾上腺恶性肿瘤;CT 示畸胎瘤或错构瘤可能;术后病理证实为成熟性畸胎瘤。随访1年,未见局部转移或远处复发征象。结论肾上腺畸胎瘤是较罕见的生殖细胞来源肿瘤,临床症状及体征不典型,影像学检查是诊断的重要依据,病理检查是确诊的根本依据,应尽早手术切除;成熟畸胎瘤手术切除预后良好,未成熟畸胎瘤术后易复发,需化疗辅助治疗,且终身随访。     

Retroperitoneal mature teratoma 15 years after initial treatment of testicular mixed germ cell tumor

We present a patient with a retroperitoneal tumor noted 15 years after treatment of a testicular mixed germ cell cancer. The patient initially underwent right-sided orchiectomy and retroperitoneal lymph node dissection for clinical stage I disease. An early relapse indicated by increasing tumor markers shortly after retroperitoneal lymph node dissection was successfully treated with five cycles of combined chemotherapy. However, 187 months after completion of chemotherapy, a symptomatic right-sided iliac mass was diagnosed. Radical surgical excision of the mass was performed and histologic examination revealed differentiated mature teratoma. This represents the longest time interval reported in the literature for a mature teratoma following treatment of a testicular germ cell tumor.     

CLINICAL EXPERIENCE WITH YOLK SAC TUMORS AND TERATOMA IN CHILDREN

Between 1971 and 1993, 12 children with testicular germ cell tumors were treated at the Department of Urology, Faculty of Medicine, Kyoto University. Seven patients had yolk sac tumors and 5 had mature teratoma. Of the 7 patients with yolk sac tumors, 6 had stage I and 1 had stage III tumors. Initial management of the stage I tumors consisted of high orchiectomy in 5 patients and high orchiectomy plus retroperitoneal lymph node dissection in 1 patient. Of these 6 patients, 4 were cured by surgery alone but lung metastases developed in the other 2 patients. One of them was salvaged with thoracotomy and chemotherapy but the other died of tumor. The patient with stage III tumor had bulky tumor spread to lung and retroperitoneum, but seems to have been cured by chemotherapy followed by resection of the residual mass although follow-up is still inadequate (14 months). Six of the 7 patients (85.7%) are alive 13 months to 21 years after diagnosis. Five patients with mature teratoma were treated by high orchiectomy or, more recently, enucleation and all are alive 4 months to 22 years after surgery.