精母细胞型精原细胞瘤的临床病理分析  

Clinicopathologic analysis of spermatocytic seminoma

作　　者：田保玲[1] 高霭峰[1] 徐灿[1] 常筱颖[1] 杨向红[1] 徐振群 苏庆华 

机构地区：[1]中国医科大学附属盛京医院病理科,沈阳110004 [2]泌尿外科 [3]超声科

出　　处：《中华病理学杂志》2012年第11期752-755,共4页Chinese Journal of Pathology

摘　　要：目的探讨精母细胞型精原细胞瘤的临床病理特征及生物学行为。方法收集中国医科大学附属盛京医院病理科2003年1月至2011年5月间病理诊断为睾丸精原细胞瘤68例，精母细胞型精原细胞瘤3例。分析患者临床资料，进行HE及免疫组织化学sP法染色，并对患者进行随访。结果经复查，确认66例为睾丸精原细胞瘤，5例为精母细胞型精原细胞瘤。这5例患者年龄平均53岁，均为临床I期，无隐睾史，不伴其他生殖细胞肿瘤，免疫组织化学示CK、波形蛋白、OCT3／4、胎盘碱性磷酸酶（PLAP）等均阴性，PAS糖原染色亦阴性；1例示CDll7散在阳性，其余4例CDll7阴性。术后】1个月至6年无1例复发或转移。66例睾丸精原细胞瘤患者平均年龄37岁，约12％伴隐睾，约11％是临床Ⅱ期。免疫组织化学表现为PLAP和OCT3／4全部阳性，69．6％（32／46）CDll7阳性。随访时间1至9年，随访的28例I期患者中，有2例复发，1例死亡，Ⅱ期3例患者中1例死亡。结论精母细胞型精原细胞瘤不同于精原细胞瘤，是一少见的、独特的有低转移潜能的临床病理类型，由于它很少发生转移或肉瘤样分化，并具有良好的预后，在睾丸切除术后，可不需进一步处理，为避免过度治疗，正确的组织学诊断非常重要。Objective To study the clinicopathologic features and biological behavior of spermatocytic seminoma. Methods A retrospective analysis of patients diagnosed as seminoma, spennatocytic seminoma between January 2003 and May 2011, was performed. Clinical data, HE stained section and immunohistochemical staining （SP method） were reviewed with follow-up. Results Sixty-six cases of seminoma and 5 cases of spermatocytic seminoma were identified. The average age at the diagnosis of 5 cases of spermatocytie seminoma was 53 years, and no patient had a history of crytorchidism or germ cell tumor. All five patients had stage pT1 tumor. Immunohistochemical studies showed that spermatocytie seminoma was negative for CK, vimentin, OCT3/4, PLAP, and LCA, and PAS staining was also negative. All five patients were well after operation. In contrast, the average age at diagnosis of the 66 cases of seminoma was 37 years, in which 12% had a history of crytorchidism and 11% were in stage pT2 or the above. Immunohistochemical studies showed that seminoma was positive for OCT3/4, PLAP, and CDl17. During the follow-up, 2 patients developed metastasis and 3 patients died of the disease. Conclusions Spermatocytic seminoma is rare and appears to follow a benign clinical course Due to its favourable prognosis, further treatment is not necessary after orchidectomy. Accurate pathologic diagnosis is critical for patient management and for avoiding over-treatment.

关 键 词：睾丸肿瘤 精原细胞瘤 诊断 鉴别 

分 类 号：R737.21[医药卫生—肿瘤]