PDF(Pubmed)
Abstract：
Palpable testicular masses in men aged 20 to 50 years usually represent testicular germ cell tumors. Diagnostic work-up involves ultrasound examination as well as serum tumor markers alpha fetoprotein, beta-human chorionic gonadotropin and lactate dehydrogenase, and particularly the novel marker M371. Orchidectomy is mandatory for germ cell tumors. We report the rare case of testicular involvement by tertiary syphilis mimicking testicular neoplasms with testis-sparing management. A 46-year-old Caucasian male presented with a painless firm mass in the right testicle and multiple cutaneous plaques at the skin of the scrotum, penis and right forearm. Testicular serum tumor markers were negative. Syphilis Rapid Plasma Reagin test and Treponema pallidum immunoglobulin antibodies tests were positive. Radiological examination revealed bilateral testicular lesions as well as bipulmonal pleural-based opacities. Conservative management was attempted and treatment with ceftriaxone (2 g/day) intravenously for 14 days was administered. The testicular findings improved rapidly and significantly during antibiotic treatment. Radiological follow-up examinations after two weeks and two months showed further regression of the testicular and pulmonary lesions. This case represents an extremely rare testicular manifestation of tertiary syphilis. Due to rising syphilis incidence in Europe, tertiary syphilis with formation of gumma should be a differential diagnosis of testicular tumor. Thus, syphilis-specific treatment is safe and orchidectomy can be avoided.
摘要：
20至50岁男性可触及的睾丸肿块通常代表睾丸生殖细胞肿瘤。诊断检查包括超声检查以及血清肿瘤标志物甲胎蛋白，β-人绒毛膜促性腺激素和乳酸脱氢酶，特别是新型标记M371。生殖细胞肿瘤必须进行睾丸切除术。我们报告了罕见的三级梅毒睾丸受累病例，模仿睾丸肿瘤并进行保留睾丸的管理。一名46岁的白种人男性在右睾丸出现无痛的坚硬肿块，在阴囊皮肤出现多个皮肤斑块，阴茎和右前臂。睾丸血清肿瘤标志物阴性。梅毒快速血浆Reagin试验和梅毒螺旋体免疫球蛋白抗体试验均为阳性。放射学检查显示双侧睾丸病变以及双肺胸膜混浊。尝试保守治疗，并静脉注射头孢曲松（2g/天）治疗14天。在抗生素治疗期间，睾丸发现迅速且显着改善。两周和两个月后的放射学随访检查显示睾丸和肺部病变进一步消退。此病例代表了三级梅毒的极为罕见的睾丸表现。由于欧洲梅毒发病率上升，三级梅毒伴牙龈瘤的形成应作为睾丸肿瘤的鉴别诊断。因此，梅毒特异性治疗是安全的，可以避免睾丸切除术。
