同時性與異時性雙側睪丸精原細胞瘤: 病例報告及文獻回顧

林介山^1,2,3、林奇柏¹、陳建凱¹、周明智²

彰化基督教醫院 外科部 泌尿科¹；中山學大學 醫學研究所²

；彰化基督教兒童醫院³

Synchronous and Metachronous Bilateral Testicular Seminoma:

 Report of two cases and literature review

Jesun Lin ^1,2,3, Chibo Lin¹, Jiankay Chen¹, and Ming-Chih Cho²

1, Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua

2, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan

3, Division of Pediatric Urology, Changhua Christian Children Hospital, Changhua

Purpose: Testis cancer is the most common tumor detected in men aged from 20 to 35 years accounting for 1-2%. About 20-30% of patients are presenting with pure seminoma of the testis. We would present our experience of synchronous and metachronous bilateral testicular seminoma in recently over 30 years.

Materials and Methods: This is a review article. The episode happened in 30 years ago. A 28 years old male patient was suffered from abdominal pain because intestinal obstruction. The emergency operation was performed and revealed a huge mass in right lower pelvic cavity causing intestinal obstruction. The huge mass was an undescended right testis tumor with intra-peritoneum carcinomatosis with lymph nodes metastasis. There was also a protruding mass over left inguinal area simultaneously. The pathology revealed both testes pure seminoma. The other patient was a 26 years old young man. He was found to be pure seminoma in 2011 and was performed left radical orchiectomy and then complete course chemotherapy. He was following up the tumor markers and image study every 6 months or one year. The metachronous seminoma of right testis was diagnosed in 2023.

Results: The patient with synchronous undescended testes seminoma died within 6 months in spite of appropriate treatment 30 year ago. The metachronous seminoma attacked over the contra-lateral testis 12 years after previous one. The patient was performed radical orchiectomy and chemotherapy.

Conclusion: The incidence of bilateral seminoma was related to the histological type of the initial tumor and to the patient's age at initial presentation in patients with seminoma. These findings have potentially important implications for clinical management by identifying a population of patients with seminoma who are at risk of developing a second tumor. It also suggests a recent increase in incidence of bilateral testicular tumors as possibly related to improved treatment modalities with a higher cure rate of the original sminoma.