睾丸及睾丸旁横纹肌肉瘤的诊断与治疗(附7例报告)
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摘要
目的探讨睾丸及睾丸旁横纹肌肉瘤的诊治方式及进展。方法回顾性分析2012年至2018年我院收治的7例睾丸及睾丸旁横纹肌肉瘤患者的临床资料。患者平均年龄(18.50±5.06)岁,肿瘤位于右侧4例、左侧3例。术前7例均行彩超、CT及MRI检查,提示睾丸肿瘤。7例均行睾丸根治性切除术,其中4例行腹腔镜下腹膜后淋巴结清扫术。术后6例行化疗,1例拒绝化疗出院。结果 7例睾丸切除手术均顺利。病理诊断6例为睾丸及睾丸旁胚胎性横纹肌肉瘤,1例为胚胎性伴局部多形性横纹肌肉瘤。4例腹腔镜淋巴结清扫手术顺利,术后无明显并发症。6例化疗患者中仅1例因化疗不良反应严重而终止。7例中6例患者接受电话随访,其中3例无瘤生存,2例仍在化疗,1例Ⅳ期患者2年后因肺部、腹膜后、椎体及纵膈多发转移而死亡;1例患者拒绝化疗后失访。结论睾丸及睾丸旁横纹肌肉瘤呈高度恶性,易复发及转移,应综合治疗,睾丸根治性切除术及腹腔镜下腹膜后淋巴结清扫术联合辅助性化疗效果良好。
Objective To explore diagnosis and treatment of testicular and paratesticular rhabdomyosarcoma. Methods The clinical data of 7 cases with testicular and paratesticular rhabdomyosarcoma were retrospectively analyzed.Their mean age was(18.50±5.06)years old.The tumor was found on the right side in four cases while the left side in three cases.The diagnosis of testicular tumor was set up by B-ultrasound,CT and MRI.All patients underwent testicular radical resection,including 4 cases who underwent laparoscopy retroperitoneal lymph node dissection.Chemotherapy was administered in 6 cases,but 1 case refused and discharged from hospital. Results Seven cases of testicular surgery were completed successfully.Pathological examination revealed embryonal rhabdomyosarcoma in 6 cases,embryonal and local pleomorphism in 1 case.Four cases of laparoscopy lymph node dissections were completed successfully without surgical complications.Chemotherapy was administered successfully in 5 patients;due to serious side effects,1 case terminated.During a follow-up by telephone till now,3 patients survived,2 cases still received chemotherapy,1 case died of recurrent disease,1 case lost to follow-up. Conclusions Testicular and paratesticular rhabdomyosarcoma is highly malignant with a frequent tendency of recurrence and metastasis.Orchiectomy and laparoscopy retroperitoneal lymph node dissection should be performed in patients,and it is effective in combination with adjuvant chemotherapy.
Objective To explore diagnosis and treatment of testicular and paratesticular rhabdomyosarcoma. Methods The clinical data of 7 cases with testicular and paratesticular rhabdomyosarcoma were retrospectively analyzed.Their mean age was(18.50±5.06)years old.The tumor was found on the right side in four cases while the left side in three cases.The diagnosis of testicular tumor was set up by B-ultrasound,CT and MRI.All patients underwent testicular radical resection,including 4 cases who underwent laparoscopy retroperitoneal lymph node dissection.Chemotherapy was administered in 6 cases,but 1 case refused and discharged from hospital. Results Seven cases of testicular surgery were completed successfully.Pathological examination revealed embryonal rhabdomyosarcoma in 6 cases,embryonal and local pleomorphism in 1 case.Four cases of laparoscopy lymph node dissections were completed successfully without surgical complications.Chemotherapy was administered successfully in 5 patients;due to serious side effects,1 case terminated.During a follow-up by telephone till now,3 patients survived,2 cases still received chemotherapy,1 case died of recurrent disease,1 case lost to follow-up. Conclusions Testicular and paratesticular rhabdomyosarcoma is highly malignant with a frequent tendency of recurrence and metastasis.Orchiectomy and laparoscopy retroperitoneal lymph node dissection should be performed in patients,and it is effective in combination with adjuvant chemotherapy.
引文
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[9]朱黎,郝金钢.睾丸生殖细胞肿瘤影像学表现[J].实用放射学杂志,2017,33(11):1714-1716,1727.
[10]Skrzypek K,Kusienicka A,Trzyna E,et al.SNAIL is a key regulator of alveolar rhabdomyosarcoma tumor growth and differentiation through repression of MYF5and MYOD function[J].Cell Death Dis,2018,9(6):643-649.
[11]Yi J,Zhou DA,Huo JR,et al.Primary intratesticular rhabdomyosarcoma:A case report and literature review[J].Oncol Lett,2016,11(2):1016-1020.
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[13]郝宗耀,叶元平,刘明,等.152例睾丸肿瘤的临床诊治分析[J].现代泌尿生殖肿瘤杂志,2013,5(3):139-142.
[14]Lin C,Donaldson SS,Meza JL,et al.Effect of radiotherapy techniques(IMRT vs.3D-CRT)on outcome in patients with intermediate-riskrhabdomyosarcoma enrolled in COGD9803-a report from the Children's Oncology Group[J].Int JRadiat Oncol Biol Phys,2012,82(5):1764-1770.
[15]Walterhouse D,Watson A.Optimal management strategies for rhabdomyosarcoma in children[J].Paediatr Drugs,2007,9(6):391-400.
[2]Dangle PP,Correa A,Tennyson L,et al.Current management of paratesticular rhabdomyosarcoma[J].Urol Oncol,2016,34(2):84-92.
[3]Han T,Chen J,Luan Y,et al.Successful treatment of relapsed testicularembryonal rhabdomyosarcoma with Endostar and traditional chemotherapy:a case report[J].Onco Targets Ther,2018,11(2):5287-5291.
[4]Chen E,Ricciotti R,Futran N,et al.Head and Neck Rhabdomyosarcoma:Clinical and Pathologic Characterization of Seven Cases[J].Head Neck Pathol,2017,11(3):321-326.
[5]de Lambert G,Chargari C,Minard-Colin V,et al.Testicular transposition in children undergoing brachytherapy for bladder and/or prostate rhabdomyosarcoma[J].J Pediatr Surg,2018,53(7):1428-1431.
[6]Chovanec M,Albany C,Mego M,et al.Emerging prognostic biomarkers in testicular germ cell tumors:looking beyond established practice[J].Front Oncol,2018,8:571.
[7]方毅,王学梅,董鲜普.超声鉴别诊断不同类型的睾丸恶性肿瘤[J].中国介入影像与治疗学,2012,9(9):685-688.
[8]魏伟,李伟宁,陈韵彬.睾丸原发肿瘤的MSCT诊断(附10例分析)[J].中国CT和MRI杂志,2010,8(3):61-64.
[9]朱黎,郝金钢.睾丸生殖细胞肿瘤影像学表现[J].实用放射学杂志,2017,33(11):1714-1716,1727.
[10]Skrzypek K,Kusienicka A,Trzyna E,et al.SNAIL is a key regulator of alveolar rhabdomyosarcoma tumor growth and differentiation through repression of MYF5and MYOD function[J].Cell Death Dis,2018,9(6):643-649.
[11]Yi J,Zhou DA,Huo JR,et al.Primary intratesticular rhabdomyosarcoma:A case report and literature review[J].Oncol Lett,2016,11(2):1016-1020.
[12]Dang ND,Dang PT,Samuelian J,et al.Lymph node management in patients with paratesticular rhabdomyosarcoma:apopulationbased analysis[J].Cancer,2013,119(17):3228-3233.
[13]郝宗耀,叶元平,刘明,等.152例睾丸肿瘤的临床诊治分析[J].现代泌尿生殖肿瘤杂志,2013,5(3):139-142.
[14]Lin C,Donaldson SS,Meza JL,et al.Effect of radiotherapy techniques(IMRT vs.3D-CRT)on outcome in patients with intermediate-riskrhabdomyosarcoma enrolled in COGD9803-a report from the Children's Oncology Group[J].Int JRadiat Oncol Biol Phys,2012,82(5):1764-1770.
[15]Walterhouse D,Watson A.Optimal management strategies for rhabdomyosarcoma in children[J].Paediatr Drugs,2007,9(6):391-400.
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