與原發處不同組織學特徵之轉移性睪丸癌：兩個案例經驗及文獻回顧

蕭伯任¹、宋文瑋^1,2,3、謝佐宜^1,2,3、陳文榮^1,2,3、王紹全^1,2,3、陳順郎^1,2,3、楊旻鑫^1,2,3

¹中山醫學大學附設醫院泌尿科；²中山醫學大學醫學院；³中山醫學大學醫學研究所

Metastatic Testicular Cancer with Different Histological Characteristics from Primary Site: Our Experience of Two Cases and Review of Literature

Po-Ren, Hsiao¹、Wen-Wei, Sung^1,2,3、Tzuo-Yi, Hsieh^1,2,3、Wen-Jung, Chen^1,2,3、Shao-Chuan, Wang^1,2,3、Sung-Lang, Chen^1,2,3、Min-Hsin, Yang^1,2,3

¹Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan; ²School of Medicine and ³Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan

Case Presentation:

A 32-year-old male presented with left flank pain and macroscopic hematuria. Imaging study revealed para-aortic metastatic lymphadenopathies, tumor extension into left renal vein and bilateral lung metastasis. (Fig. 1, 2) Pathological study reported left testicular seminoma; nevertheless, the immunostaining of the ureteral and pulmonary tumors was regarded as choriocarcinoma.

The other case was an 18-year-old boy having intermittent epigastric pain. Dilation of common bile duct, intrahepatic ducts and pancreatic duct was noted by ultrasound, and CT disclosed multiple retroperitoneal and mesenteric masses with pancreatic head invasion. (Fig. 3) Pathology from biopsy over retroperitoneal lymph node and ampulla of Vater was both germ cell tumor, and right testis disclosed 60% teratoma and 40% yolk sac tumor.  

Discussion:

Synchronous presentation of more than one histological characteristic in the same patient is considered to be very rare, but this is not in the case of testicular cancer. Several case reports claimed multiple subtypes of germ cell tumors happening in the same patient with distinct metastatic sites, including mediastinum and maxillary gingiva. Previous studies also provided strong theoretical and clinical data suggesting an insidious common pathogenetic mechanism concerning genetic instability or abnormalities during the pluripotent embryonic differentiation and maturation of the germ cell. It has the capacity for histological conversion to more differentiated forms. The potential for testicular cancer to transform or metastasize as a pathologically different cancer compared to the primary tumor can considerably alter a patient’s treatment and prognostic outcomes.