睾丸伴有合体滋养叶细胞的精原细胞瘤3例临床病理特点及文献复习
|
摘要
目的:探讨伴有合体滋养叶细胞成分的睾丸精原细胞瘤的临床及病理学特征。方法:应用光镜对3例伴有合体滋养叶细胞成分的睾丸精原细胞瘤进行病理组织学特征、诊断、鉴别诊断及结合临床进行预后分析,并复习相关文献。结果:3例均为典型精原细胞瘤基础上伴有合体滋养叶细胞。免疫表型:一致性肿瘤细胞弥漫强表达CD117、OCT-4、SALL4、PLAP,合体滋养叶细胞表达hCG。随访:2例术后行化疗,连续监测血清β-hCG水平均正常,现一般情况良好;1例会诊病例术后血清β-hCG水平正常,常规化疗后,一般情况良好。结论:睾丸精原细胞瘤常见,但睾丸精原细胞瘤伴有合体滋养叶细胞及血清β-hCG增高者罕见,是一种少见的睾丸生殖细胞肿瘤亚型,其好发于年轻患者,对化疗敏感,预后相对较好,此亚型需引起临床及病理医师重视,以避免误诊。
Objective: To investigate the clinical and histopathologic features of testicular seminoma with syncytoplasmic trophoblastic components. Methods: Using light microscopic staining, we analyzed the clinical and histopathologic characteristics, diagnosis, differential diagnosis and prognosis of 3 cases of testicular seminoma with syncytoplasmic trophoblastic components, and reviewed the relevant literature. Results: All the 3 cases were typical seminoma with syncytiotrophoblastic giant cells. Immunohistochemistry showed strong expressions of CD117 OCT-4, SALL4 and PLAP in diffuse tumor cells, and that of hCG in syncytiotrophoblastic cells. Continuous monitoring and consultation exhibited normal levels of serum β-hCG in all the cases after postoperative chemotherapy. Conclusion: Testicular seminoma with syncytiotrophoblastic giant cells and increased serum β-hCG is a rare subtype, which occurs mostly in young people, sensitive to chemotherapy postoperatively and with a relatively good prognosis.
Objective: To investigate the clinical and histopathologic features of testicular seminoma with syncytoplasmic trophoblastic components. Methods: Using light microscopic staining, we analyzed the clinical and histopathologic characteristics, diagnosis, differential diagnosis and prognosis of 3 cases of testicular seminoma with syncytoplasmic trophoblastic components, and reviewed the relevant literature. Results: All the 3 cases were typical seminoma with syncytiotrophoblastic giant cells. Immunohistochemistry showed strong expressions of CD117 OCT-4, SALL4 and PLAP in diffuse tumor cells, and that of hCG in syncytiotrophoblastic cells. Continuous monitoring and consultation exhibited normal levels of serum β-hCG in all the cases after postoperative chemotherapy. Conclusion: Testicular seminoma with syncytiotrophoblastic giant cells and increased serum β-hCG is a rare subtype, which occurs mostly in young people, sensitive to chemotherapy postoperatively and with a relatively good prognosis.
引文
[1] 郑连文,李付彪,刘睿智,等.睾丸肿瘤87例临床分析.中华男科学杂志,2005,11(6):445-447.
[2] 张东青,许纯孝,吕家驹,等.原发性性腺外精原细胞瘤(附5例报告及文献复习).中国癌症杂志,2002,12(2):127-129.
[3] Hedinger C,von Hochstetter AR,Egloff B.Seminoma with syncytiotrophoblastic giant cells:A special form of seminoma.Virchows Archiv A,1979,383(1):59-67.
[4] Bjurlin MA,August CZ,Weldonlinne M,et al.Histologically pure stage I seminoma with an elevated beta-hCG of 4497 IU/l.Urology,2007,70(5):1007.e13-e15.
[5] 牛晓东,王海平,黄勇.睾丸精原细胞瘤伴高beta-HCG一例并文献复习.实用医学杂志,2010,26(20):3852-3852.
[6] Jacobsen GK,von der Maase H,Specht L.Histopathological features of stage I seminoma treated with orchidectomy only.J Urol Pathol,1995,54(3):85-94.
[7] 张宏艳,刘端祺.睾丸肿瘤流行病学研究进展.解放军医学杂志,2007,32(3):274-275.
[8] Mostofi FK,Sesterhenn IA.Pathology of germ cell tumors of testes.Prog Clin Biol Res,1985,203:1-34.
[9] Hartmann M,Pottek T,Bussarmaatz R,et al.Elevated human chorionic gonadotropin concentrations in the testicular vein and in peripheral venous blood in seminoma patients.An analysis of various parameters.Eur Urol,1997,31(4):408-413.
[10] Hori K,Uematsu K,Yasoshima H,et al.Testicular seminoma with human chorionic gonadotropin production.Pathol Int,2010,47(9):592-599.
[11] Weissbach L,Bussar-Maatz R,L?hrs U,et al.Prognostic factors in seminomas with special respect to hCG:Results of a prospective multicenter study.Eur Urol,1999,36(6):601-608.
[12] Ohr J.Tumors of the testis,adnexa,spermatic cord,and scrotum.Arch Patho Lab Med,2000,124(12):1855.
[13] Tickoo SK,Hutchinson B,Bacik J,et al.Testicular seminoma:A clinicopathologic and immunohistochemical study of 105 cases with special reference to seminomas with atypical features.Int J Surg Pathol,2002,10(1):23.
[14] Vallis KA,Howard GC,Duncan W,et al.Radiotherapy for stages I and II testicular seminoma:Results and morbidity in 238 patients.Br J Radiol,1995,68(808):400-405.
[15] Berney DM,Lee A,Randle SJ,et al.The frequency of intratubular embryonal carcinoma:Implications for the pathogenesis of germ cell tumours.Histopathology,2010,45(2):155-161.
[16] Aissa A,Marnouche E,Elkacemi H,et al.Role of radiotherapy in stage I testicular seminomas:About 25 cases.Pan Afr Med J,2016,25:53.
[2] 张东青,许纯孝,吕家驹,等.原发性性腺外精原细胞瘤(附5例报告及文献复习).中国癌症杂志,2002,12(2):127-129.
[3] Hedinger C,von Hochstetter AR,Egloff B.Seminoma with syncytiotrophoblastic giant cells:A special form of seminoma.Virchows Archiv A,1979,383(1):59-67.
[4] Bjurlin MA,August CZ,Weldonlinne M,et al.Histologically pure stage I seminoma with an elevated beta-hCG of 4497 IU/l.Urology,2007,70(5):1007.e13-e15.
[5] 牛晓东,王海平,黄勇.睾丸精原细胞瘤伴高beta-HCG一例并文献复习.实用医学杂志,2010,26(20):3852-3852.
[6] Jacobsen GK,von der Maase H,Specht L.Histopathological features of stage I seminoma treated with orchidectomy only.J Urol Pathol,1995,54(3):85-94.
[7] 张宏艳,刘端祺.睾丸肿瘤流行病学研究进展.解放军医学杂志,2007,32(3):274-275.
[8] Mostofi FK,Sesterhenn IA.Pathology of germ cell tumors of testes.Prog Clin Biol Res,1985,203:1-34.
[9] Hartmann M,Pottek T,Bussarmaatz R,et al.Elevated human chorionic gonadotropin concentrations in the testicular vein and in peripheral venous blood in seminoma patients.An analysis of various parameters.Eur Urol,1997,31(4):408-413.
[10] Hori K,Uematsu K,Yasoshima H,et al.Testicular seminoma with human chorionic gonadotropin production.Pathol Int,2010,47(9):592-599.
[11] Weissbach L,Bussar-Maatz R,L?hrs U,et al.Prognostic factors in seminomas with special respect to hCG:Results of a prospective multicenter study.Eur Urol,1999,36(6):601-608.
[12] Ohr J.Tumors of the testis,adnexa,spermatic cord,and scrotum.Arch Patho Lab Med,2000,124(12):1855.
[13] Tickoo SK,Hutchinson B,Bacik J,et al.Testicular seminoma:A clinicopathologic and immunohistochemical study of 105 cases with special reference to seminomas with atypical features.Int J Surg Pathol,2002,10(1):23.
[14] Vallis KA,Howard GC,Duncan W,et al.Radiotherapy for stages I and II testicular seminoma:Results and morbidity in 238 patients.Br J Radiol,1995,68(808):400-405.
[15] Berney DM,Lee A,Randle SJ,et al.The frequency of intratubular embryonal carcinoma:Implications for the pathogenesis of germ cell tumours.Histopathology,2010,45(2):155-161.
[16] Aissa A,Marnouche E,Elkacemi H,et al.Role of radiotherapy in stage I testicular seminomas:About 25 cases.Pan Afr Med J,2016,25:53.