大動脈を合併切除した精巣腫瘍,化学療法後の残存腫瘍摘除術の1例

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59歳男性.患者は心窩部痛を主訴に,精査目的に著者らの施設へ入院となった.入院時,触診上腹部正中と左精巣尾側に腫瘤を触知し,腫瘍マーカーはCEAが高値を示した.腹部造影CTでは大動脈前面から左側に直径10cmと6cmの造影効果に乏しい嚢胞性腫瘍を認め,精巣腫瘍を疑い左高位精巣摘除術を施行した.病理組織学的に左精巣腫瘍(mature teratoma)による後腹膜リンパ節転移と診断され,BEP療法を3コース行ったが,治療効果はNCであったため,残存腫瘍と癒着した大動脈を合併切除し,人工血管で再建した.その結果,術後,血清CEAは正常化し,術後1年6ヵ月経過した現在,再発なく経過良好であるA 59-year-old man visited our hospital complaining of epigastralgia. A large hard mass was palpable in the abdominal cavity. Abdominal computed tomography revealed large retroperitoneal cystic tumors. His left testis was hard and swollen. Under the diagnosis of testicular tumor and retroperitoneal lymph node metastasis, left radical orchiectomy was performed and the histopathological examination showed mature teratoma. He was diagnosed with nonseminomatous germ cell tumor and retroperitoneal lymph node metastasis (TNM classification stage IIC). He received three cycles of chemotherapy with bleomycin, etoposide, and cisplatin and we performed retroperitoneal residual tumor resection. Because the tumor tightly adhered to the aortic wall, abdominal aorta was resected and replaced by an artificial vessel. The post-operative course was uneventful. Histopathological diagnosis was cystopapillary adenocarcinoma and mature teratoma. The patient is well 1 and a half years after the operation without recurrence.

大動脈を合併切除した精巣腫瘍,化学療法後の残存腫瘍摘除術の1例

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