原发性生殖系统恶性间皮瘤2例报告并文献复习  

Primary malignant mesothelioma of the reproductive system:two cases report and literature review

作　　者：曹松强 赵振华 李松 刘辉 张建华 侯俊清 CAO Songqiang;ZHAO Zhenhua;Ll Song;LIU Hui;ZHANG Jianhua;HOU Junqing(Department of Urology,Huaihe Hospital of Henan University,Kaifeng 475000,CHN;Henan Prostate Disease Prevention and Diagnosis Engineering Research Center,Kaifeng 475000,CHN)

机构地区：[1]河南大学淮河医院泌尿外科,河南开封475000 [2]河南省前列腺疾病预防与诊断工程研究中心,河南开封475000

出　　处：《河南大学学报（医学版）》2023年第4期251-255,共5页Journal of Henan University:Medical Science

基　　金：河南省重点研发与推广专项(科技攻关)(212102310685);河南省医学科技攻关计划(LHGJ20210578);开封市科技发展计划(2106006);河南大学医学院重点培育一流学科建设(CX3011A0950017)。

摘　　要：目的:分析并总结附睾和睾丸原发性恶性间皮瘤的发病特点、临床特征、诊治和预后。方法:回顾性分析某医院收治的1例附睾恶性间皮瘤和1例睾丸恶性间皮瘤的临床特点、诊治流程和治疗方法,并结合国内外相关文献对其临床特点、疾病特征和治疗方法进行探讨。结果:2例恶性间皮瘤患者经术前检查后分别行附睾及睾丸切除术。附睾病理标本结果:附睾恶性间皮瘤,肿瘤侵犯睾丸白膜;免疫组化结果:CK(+),VIM(+),CK7(+),CK5/6(+),WT-1(+),CR(+),D2-40(+),KI67(+30%);术后给以辅助化疗治疗,随访至第19个月出现肺部转移。睾丸病理标本结果:睾丸恶性间皮瘤;免疫标记:CK(+),Vimentin(+),CD117(灶+),D2-40(+),CD34(血管+),CD31(血管+),CR(+),KI67(+20%);患者分别行睾丸根治性切除术和机器人辅助腹腔镜腹膜后淋巴结清扫术,术后随访17个月未见肿瘤复发。结论:生殖系统恶性间皮瘤是一种罕见的高度侵袭性恶性肿瘤,预后极差,术前诊断困难,易出现复发转移,确诊依靠组织病理学检查,治疗推荐以根治性切除手术为主,可行淋巴结清扫术,术后可辅助化疗,需长期密切随访观察。Objective:To analyze and summarize the pathogenesis,clinical features,diagnosis,treatment and prognosis of primary malignant mesothelioma of epididymis and testis.Methods:The clinical characteristics,diagnosis and treatment procedures and treatment methods of 1 case of epididymal malignant mesothelioma and 1 case of testicular malignant mesothelioma treated in one hospital were retrospectively analyzed,and their clinical characteristics,disease characteristics and treatment methods were discussed in combination with relevant domestic and foreign literature.Results:Two patients with malignant mesothelioma underwent testicular and epididymal resection after preoperative diagnosis.The results of epididymal pathological specimens showed:epididymal malignant mesothelioma,tumor invaded the testicular tunica albuginea,immunohistochemical results:CK(+),VIM(+),CK7(+),CK5/6(+),WT-1(+),CR(+),D2-40(+),KI67(+30%);Adjuvant chemotherapy was given after the operation,and pulmonary metastases at follow-up to month 19.The results of testicular pathological specimens showed:testicular malignant mesothelioma,immune markers:CK(+),Vimentin(+),CD117(focus+),D2-40(+),CD34(vascular+),CD31(vascular+),CR(+),KI67(+20%);the patients underwent a second radical testicular resection and Robot-assisted laparoscopic retroperitoneal lymph node dissection in the outside hospital respectively;no tumor recurrence was found in the 8-month follow-up.Conclusion:Malignant mesothelioma of the reproductive system is a rare and highly aggressive malignant tumor with an extremely poor prognosis,difficult inpreoperative diagnosis,and prone to recurrence and metastasis.Lymph node dissection was performed if necessary.Postoperative adjuvant chemotherapy is possible,and long-term close follow-up is required.

关 键 词：附睾肿瘤 睾丸肿瘤 恶性间皮瘤 文献复习 

分 类 号：R737.2[医药卫生—肿瘤]