雙側睪丸生殖細胞腫瘤之案例報告
戴盟哲1、郭俊逸1,2、林登龍1,2
台北榮民總醫院 泌尿部1；國立陽明大學醫學院 泌尿學科 書田泌尿科學研究中心2
Bilateral testicular germ cell tumors - A Case Report
Meng-Che Tai1, Junne-Yih Kuo1,2, Alex T.L. Lin1,2
Department of Urology, Taipei Veterans General Hospital1
Department of Urology, School of Medicine and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan2
Introduction:
Testicular cancer is the most common tumor type in young males. The testicular germ cell tumors (TGCTs) account for 90-95%. The incidence of bilateral TGCT varies from 1% to 5%, which approximately 65% is metachronous tumors at diagnosis. Herein, we share our experience of metachronous bilateral testicular germ cell tumor.
Case report:
A 29-year-old man with no past medical or operation history presented with right painless scrotal mass. At first, he visited other hospital for help. Physical examination revealed an enlarged non-tender firm right testicular mass. Beta human chorionic gonadotropin (β-HCG) was 39.7 mIU/mL (normal <5.0) and alfa-fetoprotein (AFP) was 10.89 ng/mL (normal <20.0). The computer tomography(CT) of the abdomen did not demonstrate any enlarged retroperitoneal lymph nodes. The chest X-ray showed no abnormality. Then, the patient underwent right radical orchiectomy. The pathology demonstrated anaplastic seminoma, stage I. After operation, he went to our hospital and he was followed up with physical examination, tumor marker assessments and image studies. After three years of the disease -free period, palpable mass was noted at left testis. Scrotal ultrasound showed microlithiasis and a hypoechoic nodule with increased vascularity measuring 2.5x1.7cm, which germ cell tumor should be considered. After well discussion, he received left radical orchiectomy for oncological outcome. The pathology report for left testis tumor showed seminoma, pT1. Therefore, he didn't receive further adjuvant therapy after surgery and he had been followed at outpatient department for one year. There was no recurrence or metastases and tumor markers were within normal limit. Besides, the hormone replacement was given with daily topical testosterone postoperatively.
Conclusion:
For bilateral testicular germ cell tumor, bilateral radical orchiectomy is generally considered as standard therapy. If the tumor volume is less than 30% of the testicular volume, partial orhiectomy could be considered in selected cases and further adjuvant treatment should be given. Because the presence of bilateral concordant histology had worse 5-year disease-specific survival and overall survival by systematic review, we should treat more aggressively if tumor recurrence or metastases was suspected clinically.