睾丸原发性类癌的临床病理学观察

目的:探讨原发于睾丸的类癌临床病理学特征、免疫表型、鉴别诊断及其组织起源。方法:应用光镜、免疫组织化学对4例原发于睾丸的类癌进行检测。结果:4例患者均表现为阴囊肿块,病程2～36年,其中2例伴有会阴胀痛感。肿块呈结节状,直径3.0～4.0cm,切面灰黄色,界清,1例有灶性坏死。组织学上,癌细胞呈圆形、多角形,胞质略嗜伊红颗粒状,胞界不清。核单一,圆形,染色质点彩状。癌细胞排列呈岛状、梁状,可见小的规则的菊形团样结构及大的不规则腺管样结构,腺腔内可见红染的分泌物。癌巢间为纤细的纤维组织间隔。免疫表型,癌细胞弥漫性表达突触素、嗜铬素、神经元特异性烯醇酶和细胞角蛋白。结论:睾丸原发性类癌罕见,组织起源有争议。该肿瘤应与精原细胞瘤、转移性类癌、支持细胞瘤及粒层细胞瘤等鉴别。

Clinicopathological Study of Primary Carcinoid Tumor of the Testis

OBJECTIVE: To study the clinicopathological characteristics, immunohistochemical features and histogenesis of primary testicular carcinoid tumor and its differential diagnosis. METHODS: Light microscopy and immunohistochemical stains were performed in 4 cases of primary testicular carcinoid tumor. RESULTS: The patients sought care for scrotum mass presented from 2 to 36 years, 2 cases accompanied with tender swelling of the testis. The tumors were described as nodular, yellowish-gray in color, 3.0-4.0 cm in the greatest dimensions, and well circumscribed, focal necrosis seen in 1 case. Histologically, they showed insular and trabecular patterns separated by fine fibrous bands. The tumor cells were round or polygonal with regular monomorphic nuclei, stippling chromatin and eosinophilic granular cytoplasm. There were rosette-like and tubuloglandular patterns with eosinophilic secretion in the cavity. Immunohistochemical staining for synaptophysin, chromogranin A, NSE and cytokeratin showed diffusely positive expression in the tumor cells. CONCLUSION: Primary testicular carcinoid tumor is extremely rare with good prognosis and its histogenesis remains controversial. Diagnostically it has to be differentiated from seminoma, metastatic carcinoid tumor, Sertoli cell tumor and granulosa cell tumor.