PDF(Pubmed)
Abstract：
Testicular choriocarcinoma is a relatively rare malignancy with a highly aggressive nature. Timely diagnosis and treatment can help prolong the survival of patients and even cure them. This case reports a 29-year-old male who presented to the clinic for a month with epigastric pain. On examination, a massive mass of approximately 9*10 cm could be palpated in the upper abdomen. When asked about his previous history, the patient only described a history of a right inguinal hernia that had been repaired 12 years earlier. The admission diagnosis was considered the retroperitoneal tumor, which was found to have metastasized to the liver and lungs after the completion of relevant tests. We then performed a CT-guided lune puncture biopsy on day 8 of admission. The biopsy pathology suggested metastatic cancer was considered. As the symptoms of tumor compression gradually worsened, we performed surgical treatment (retroperitoneal tumor resection + partial duodenal resection + enteroanastomosis) on day 13 of admission. The postoperative pathology was choriocarcinoma. We subsequently conducted a detailed inquiry with the patient\'s family about his medical history and found a history of inguinal testicle. Through testicular ultrasound examination, it was preliminarily determined to be testicular choriocarcinoma (not yet pathologically confirmed). We wanted to start salvage chemotherapy as soon as possible after surgery. However, the patient\'s postoperative condition was poor, with rapid progression of hepatopulmonary metastases and gradually increased thyrotoxicosis, and we started salvage chemotherapy (EP regimen: etoposide and cisplatin) on postoperative day 12. However, the patient was forced to stop due to a severe chemotherapy reaction and died of respiratory and cardiac arrest in the hospital. For male patients with retroperitoneal mass, the possibility of germ-cell neoplasm should first be excluded. By inquiring in detail about a history of cryptorchidism and in the initial days of hospitalization, testicular exploration, ultrasounds, and serum tumor markers (AFP, β-HCG) tests can be conducted to rule out the possibility of germ-cell neoplasm, thereby preventing misdiagnosis and treatment delays. If the clinical diagnosis is metastatic germ-cell tumor with severe symptoms of metastatic disease, surgery should never be used as the initial treatment.
摘要：
睾丸绒毛膜癌是一种相对罕见的恶性肿瘤，具有高度侵袭性。及时的诊断和治疗有助于延长患者的生存期，甚至治愈他们。该病例报告了一名29岁的男性，他因上腹痛到诊所就诊一个月。在检查中，可以在上腹部触诊大约9*10厘米的巨大肿块。当被问及他以前的历史时，该患者仅描述了12年前已修复的右腹股沟疝的病史。入院诊断为腹膜后肿瘤,在完成相关测试后，发现已转移到肝脏和肺部。然后，我们在入院第8天进行了CT引导下的肺穿刺活检。活检病理提示转移癌。随着肿瘤压迫的症状逐渐恶化，我们在入院第13天进行了手术治疗(腹膜后肿瘤切除术+十二指肠部分切除术+肠吻合术).术后病理为绒毛膜癌。随后，我们对患者的家人进行了详细的询问，了解他的病史，并发现了腹股沟睾丸病史。通过睾丸超声检查，初步确定为睾丸绒毛膜癌(尚未病理证实)。我们想在手术后尽快开始抢救化疗。然而,患者的术后情况较差，随着肝肺转移的快速进展和甲状腺毒症的逐渐增加，术后第12天开始抢救化疗（EP方案：依托泊苷和顺铂）。然而,该患者因严重的化疗反应而被迫停药，并在医院死于呼吸和心脏骤停。对于腹膜后肿块的男性患者，首先应排除生殖细胞肿瘤的可能性.通过详细询问隐睾病史和住院初期，睾丸探查,超声波,和血清肿瘤标志物(AFP，可以进行β-HCG）测试以排除生殖细胞肿瘤的可能性，从而防止误诊和治疗延误。如果临床诊断为转移性生殖细胞肿瘤，具有严重的转移性疾病症状，手术不应作为初始治疗。
