原发性附睾透明细胞癌一例报告并文献复习

目的探讨原发性附睾透明细胞癌的临床、病理、组织化学特性和诊治方法及预后。方法报告1例原发性附睾透明细胞癌患者临床资料，结合文献复习讨论。患者，男，43岁，因左侧阴囊无痛性包块1个月就诊。体检干左附睾头部可扪及1．0cm结节，表面光滑、质硬、无触痛。结果行左附睾切除术。组织学以大片透明样癌细胞、腺管样结构为特征。免疫组化示高分子量细胞角蛋白抗体（AE）（＋＋），AE3（＋／-），神经元特异性烯醇酶（-），间质瘤（-）。术后双肾MRI排除占位性病变，膀胱B超未见异常。术后15d行左睾丸切除术，病理未见透明细胞癌组织。随访15个月，患者无瘤存活。结论原发性附睾透明细胞癌经病理检查才能确诊，应与转移性癌及肾源型腺瘤相鉴别，治疗以根治性手术为主。

Primary clear cell carcinoma of the epididymis ( a case report and review of the literature)

Objective To evaluate the pathological,histochemical and clinical features of primary clear cell carcinoma of the epididymis,and to investigate its diagnosis,treatment and prognosis.Methods The clinical data of one case of primary clear cell carcinoma of the epididymis were reported and the relevant literature was reviewed.Results The patient was a 43-year-old man presenting with a painless mass in the left epididymis.On physical examination,a 1.0 cm-sized smooth solid nodule on the head of left epididymis could be palpated without tenderness.Then the patient underwent left epididymectomy.On postoperative histopathological study,the tumor was characterized by diffuse sheets of clear cells and adenoid structures.Immunohistochemical assay showed AE(++),AE3(+/-),NSE(-) and interstitialoma(-) in the tumor tissues.Postoperatively,MRI showed no space-occupying lesion in both kidneys,and B-ultrasound indicated no abnormality of the bladder.Fifteen days after operation,left orchiectomy was performed on the patient.Pathology showed no clear cell carcinoma tissue of the testis.Follow-up was 15 months.The patient was reported to be alive and tumor-free.Conclusions The histogenesis of primary clear cell carcinoma of epididymis is unclear yet.The diagnosis depends on pathologic studies,and should be differentiated from nephrogenic adenoma and metastatic carcinoma.Radical surgery is the main treatment choice.