附睾脂肪肉瘤腹膜后及腹腔内转移1例报告并文献复习
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摘要
目的:报告1例罕见的附睾脂肪肉瘤伴腹膜后及腹腔内多次转移病例,提高对本病的诊治水平。方法:回顾分析1例附睾脂肪肉瘤伴腹膜后及腹腔内多次转移患者的临床资料,结合国内外相关文献,探讨附睾脂肪肉瘤的临床表现、诊断及治疗。结果:经腹股沟切口行根治性高位睾丸切除术完整切除肿瘤,10年后出现腹膜后复发转移,肿块上至肾脏上极,下达盆腔,大小15.6 cm×9.4 cm×25.5 cm,包裹左肾及输尿管上段,行左肾及输尿管全长、腹膜后肿瘤切除手术,4年后再次出现腹膜后、腹腔内多发复发转移灶,再次行手术切除,随访1年,死于肺功能衰竭。结论:附睾脂肪肉瘤极为罕见,仔细的临床体检和影像学检查可协助诊断,但最终需病理确诊,应早期行根治性手术切除。放化疗对附睾脂肪肉瘤的作用存在争议。本病有较高的复发率,长期的密切随访是必要的。
Objective: To report a rare case of epididymal liposarcoma with multiple metastases to the retroperitoneal space and peritoneal cavity for the purpose of improving the diagnosis and treatment of the disease. Methods: We retrospectively analyzed the clinical data about a case of epididymal liposarcoma with multiple metastases to the retroperitoneal space and peritoneal cavity,reviewed relevant literature at home and abroad,and investigated the presentation,diagnosis and treatment of the disease. Results: A47-year-old male patient with epididymal liposarcoma underwent radical left orchiectomy with high ligation of the spermmatic cord. Ten years later,recurrence and metastasis were observed in the retroperitoneal space with a mass of 15. 6 × 9. 4 × 25. 5 cm occupying an area from the upper pole of the left kidney to the pelvic cavity and enclosing the left kidney and upper ureter,for which the patient received radical resection of the retroperitoneal tumor. However,multiple retroperitoneal and intraperitoneal metastases occurred again 4 years later,which was treated by another surgical resection. The patient died of lung failure a year later. Conclusion: Epididymal liposarcoma is a rare entity,which can be diagnosed by careful clinical and radiological examinations and confirmed by pathology. For its treatment,radical inguinal orchiectomy should be performed as early as possible,but the roles of adjuvant radiotherapy and chemotherapy remain controversial. Given the high rate of recurrence and metastasis,long-term follow-up is necessitated for the patient postoperatively. Natl J Androl,2017,23( 12) : 1103-1106
Objective: To report a rare case of epididymal liposarcoma with multiple metastases to the retroperitoneal space and peritoneal cavity for the purpose of improving the diagnosis and treatment of the disease. Methods: We retrospectively analyzed the clinical data about a case of epididymal liposarcoma with multiple metastases to the retroperitoneal space and peritoneal cavity,reviewed relevant literature at home and abroad,and investigated the presentation,diagnosis and treatment of the disease. Results: A47-year-old male patient with epididymal liposarcoma underwent radical left orchiectomy with high ligation of the spermmatic cord. Ten years later,recurrence and metastasis were observed in the retroperitoneal space with a mass of 15. 6 × 9. 4 × 25. 5 cm occupying an area from the upper pole of the left kidney to the pelvic cavity and enclosing the left kidney and upper ureter,for which the patient received radical resection of the retroperitoneal tumor. However,multiple retroperitoneal and intraperitoneal metastases occurred again 4 years later,which was treated by another surgical resection. The patient died of lung failure a year later. Conclusion: Epididymal liposarcoma is a rare entity,which can be diagnosed by careful clinical and radiological examinations and confirmed by pathology. For its treatment,radical inguinal orchiectomy should be performed as early as possible,but the roles of adjuvant radiotherapy and chemotherapy remain controversial. Given the high rate of recurrence and metastasis,long-term follow-up is necessitated for the patient postoperatively. Natl J Androl,2017,23( 12) : 1103-1106
引文
[1]徐峰,汪泓,郝金宝,等.双侧附睾巨大平滑肌瘤1例报告.中华男科学杂志,2016,22(4):382-383.
[2]Scharts SL,Swierzewski SJ,Sondak VK,et al.Liposarcoma of the spermatic cord:Report of 6 cases and review of the literature.J Urol,1995,153(1):154-157.
[3]Montgomery E,Fisher C.Paratesticular liposarcoma:A clinicopathologic study.Am J Sur Pathol,2003,27(1):40-47.
[4]郭应禄,周利群主译.坎贝尔-沃尔什泌尿外科学,第9版第1卷.北京:北京大学医学出版社,2009.965.
[5]任福锦.原发性附睾肿瘤15例分析.浙江医学.1995,17(1):35.
[6]傅龙龙,张开舒.男性青少年肿瘤患者的生育力保护.中华男科学杂志.2017,23(3):262-266.
[7]董干,修子超.男性恶性肿瘤患者生殖风险与保护.中华男科学杂志.2017,23(3):271-275.
[8]Bhosale PR,Patnana M,Viswanathan C,et al.The inguinal canal:Anatomy and imaging features of common and uncommon masses.Radiographics,2008,28(3):819-835.
[9]Ramanathan S,Raghu V,Kumar D,et al.Sclerosing liposarcoma of epididymis:Role of chemical shift magnetic resonance imaging.Indian J Radiol Imaging,2016,26(3):356-359.
[10]Gregorio MD,D'Hondt L,Lorge F,et al.Liposarcoma of the spermatic cord:An infrequent pathology.Case Rep Oncol,2017,10(1):136-142.
[11]Li FB,Tian RH,Yin CJ,et al.Liposarcoma of the spermatic cord mimicking a left inguinal hernia:A case report and literature review.Word J Surg Oncol,2013,11(1):14-18.
[12]Ushida H,Johnin K,Koizumi S,et al.Liposarcom of the spermatic cord in the left scrotum and inguinal region:A case report.Hinyiokika Kiyo,2000,46(5):349-351.
[13]Landhuis E.FDA approves Eribulin for advanced liposarcoma.Cancer Discov,2016,6(3):OF1.
[14]Coleman J,Brennan MF,Alektiar K,et al.Adult spermatic cord sarcomas:Management and results.Ann Surg Oncol,2003,10(6):669-675.
[2]Scharts SL,Swierzewski SJ,Sondak VK,et al.Liposarcoma of the spermatic cord:Report of 6 cases and review of the literature.J Urol,1995,153(1):154-157.
[3]Montgomery E,Fisher C.Paratesticular liposarcoma:A clinicopathologic study.Am J Sur Pathol,2003,27(1):40-47.
[4]郭应禄,周利群主译.坎贝尔-沃尔什泌尿外科学,第9版第1卷.北京:北京大学医学出版社,2009.965.
[5]任福锦.原发性附睾肿瘤15例分析.浙江医学.1995,17(1):35.
[6]傅龙龙,张开舒.男性青少年肿瘤患者的生育力保护.中华男科学杂志.2017,23(3):262-266.
[7]董干,修子超.男性恶性肿瘤患者生殖风险与保护.中华男科学杂志.2017,23(3):271-275.
[8]Bhosale PR,Patnana M,Viswanathan C,et al.The inguinal canal:Anatomy and imaging features of common and uncommon masses.Radiographics,2008,28(3):819-835.
[9]Ramanathan S,Raghu V,Kumar D,et al.Sclerosing liposarcoma of epididymis:Role of chemical shift magnetic resonance imaging.Indian J Radiol Imaging,2016,26(3):356-359.
[10]Gregorio MD,D'Hondt L,Lorge F,et al.Liposarcoma of the spermatic cord:An infrequent pathology.Case Rep Oncol,2017,10(1):136-142.
[11]Li FB,Tian RH,Yin CJ,et al.Liposarcoma of the spermatic cord mimicking a left inguinal hernia:A case report and literature review.Word J Surg Oncol,2013,11(1):14-18.
[12]Ushida H,Johnin K,Koizumi S,et al.Liposarcom of the spermatic cord in the left scrotum and inguinal region:A case report.Hinyiokika Kiyo,2000,46(5):349-351.
[13]Landhuis E.FDA approves Eribulin for advanced liposarcoma.Cancer Discov,2016,6(3):OF1.
[14]Coleman J,Brennan MF,Alektiar K,et al.Adult spermatic cord sarcomas:Management and results.Ann Surg Oncol,2003,10(6):669-675.