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目的:提高对睾丸恶性间质细胞瘤(TMLCT)临床病理特征的认识及无创诊断水平。方法:回顾性分析1例患者(年龄47岁)TMLCT的临床病理资料,检测患者外周血循环肿瘤细胞(CTC)并进行文献复习。结果:全麻下行根治性右睾丸肿瘤切除术。术后病理示:TMLCT,以间质细胞为主,可疑脉管癌栓。免疫组化染色示:α-抑制素(+),波形蛋白部分(+),EMA(+),PLAP(+),CD30(+),Ki67约5%(+),CK(-),CK7(-),S100(-),CD10(-),SMA(-),Des(-),AFP(-),h CG(-),CEA(-),CK19(-),CD117(-),Oct-4(-),LCA(-),CD20(-),Pax-5(-),CD3(-),CD43(-)。患者外周血中共检测到2个CTCs。术后复查因多发淋巴结转移行化疗3个疗程,随后复查CT见腹膜后淋巴结转移无明显缩小,予行腹膜后肿物切除+冷冻消融术。随访8个月复查CT见腹膜后转移淋巴结较前增大并肾上腺转移。结论:TMLCT是极罕见的性索间质肿瘤,恶性度高,预后差,而CTC有望用于其早期诊断及预后预测。
OBJECTIVE: To improve the understanding of the clinical and pathological features of TMLCT and the diagnostic value of noninvasive diagnosis. Methods: A retrospective analysis of 1 patient (aged 47 years) TMLCT clinical and pathological data, detection of peripheral blood circulating tumor cells (CTC) and literature review. Results: Radical right testes resection under general anesthesia. Postoperative pathology: TMLCT, stromal cells, suspicious vascular thrombosis. Immunohistochemical staining showed that the expression of α-statin (+), vimentin (+), EMA (+), PLAP (+), CD30 (+), Ki67 about 5% (-), CD10 (-), SMA (-), Des (-), AFP (-), hCG (-), CEA Oct-4 (-), LCA (-), CD20 (-), Pax-5 (-), CD3 (-), CD43 (-). A total of 2 CTCs were detected in peripheral blood of patients. Postoperative recidivism due to multiple lymph node metastases in 3 courses of chemotherapy, followed by review of CT showed retroperitoneal lymph node metastasis was not significantly reduced, to undergo retroperitoneal tumor resection + cryoablation. Follow-up 8 months to review CT See retroperitoneal lymph node metastasis increased and adrenal metastasis. CONCLUSION: TMLCT is an extremely rare cord tumor with high malignancy and poor prognosis. CTC is expected to be used for its early diagnosis and prognosis.