内容紹介
A Case of Biopsy Confirmed Unresectable Retroperitoneal Seminoma Successfully Treated with Chemotherapy
Summary
We herein report a case of a retroperitoneal tumor of unknown origin that was diagnosed as a seminoma after tumor biopsy and was successfully treated with chemotherapy containing bleomycin, etoposide, and cisplatin(BEP). A 47-year old man visited our hospital with left abdominal pain. An endoscopic examination revealed an ulcer lesion on the third part of the duodenum. Abdominal CT scan revealed a retroperitoneal tumor invading the abdominal aorta with the tumor thrombus in the inferior vena cava(IVC). An endoscopic biopsy could not identify the tumor's origin because of the negative staining of various surface markers on immunohistochemistry. Surgical biopsy of the unresectable retroperitoneal tumor that was finally diagnosed as a seminoma was performed. The patient was treated with BEP according to the International Germ Cell Consensus Classification(IGCCC)for risks, and orchiectomy was performed. He has been alive for 7 months with progressive shrinkage of the retroperitoneal tumor, in which 18F-fluorodeoxyglucose(FDG)positron emission tomography(PET)has shown a dramatic reduction of the maximum standardized uptake value(SUV)during chemotherapy.
要旨
症例は47歳,男性。十二指腸水平脚に潰瘍性病変を有する9 cmの後腹膜腫瘍を認め生検を施行した。低分化腺癌と診断されるが,免疫染色にて上皮系・リンパ系・間葉系・神経内分泌系のいずれのマーカーも陰性で原発不明癌と診断された。腹部CT検査では腫瘍内を大動脈,右腎動脈が貫通,下大静脈内に腫瘍栓も認め完全切除は困難であった。診断確定および治療方針決定のため開腹腫瘍生検を施行し,免疫染色にてseminomaの診断となった。胚細胞腫瘍の国際的リスク分類に準じてbleomycin,etoposide,cisplatin(BEP療法)の化学療法を施行,その後精巣摘出術が行われた。PET-CTで後腹膜腫瘍の集積は,SUVmax値7.17から化学療法後に消失し著効した。術後7か月生存中である。
目次
Summary
We herein report a case of a retroperitoneal tumor of unknown origin that was diagnosed as a seminoma after tumor biopsy and was successfully treated with chemotherapy containing bleomycin, etoposide, and cisplatin(BEP). A 47-year old man visited our hospital with left abdominal pain. An endoscopic examination revealed an ulcer lesion on the third part of the duodenum. Abdominal CT scan revealed a retroperitoneal tumor invading the abdominal aorta with the tumor thrombus in the inferior vena cava(IVC). An endoscopic biopsy could not identify the tumor's origin because of the negative staining of various surface markers on immunohistochemistry. Surgical biopsy of the unresectable retroperitoneal tumor that was finally diagnosed as a seminoma was performed. The patient was treated with BEP according to the International Germ Cell Consensus Classification(IGCCC)for risks, and orchiectomy was performed. He has been alive for 7 months with progressive shrinkage of the retroperitoneal tumor, in which 18F-fluorodeoxyglucose(FDG)positron emission tomography(PET)has shown a dramatic reduction of the maximum standardized uptake value(SUV)during chemotherapy.
要旨
症例は47歳,男性。十二指腸水平脚に潰瘍性病変を有する9 cmの後腹膜腫瘍を認め生検を施行した。低分化腺癌と診断されるが,免疫染色にて上皮系・リンパ系・間葉系・神経内分泌系のいずれのマーカーも陰性で原発不明癌と診断された。腹部CT検査では腫瘍内を大動脈,右腎動脈が貫通,下大静脈内に腫瘍栓も認め完全切除は困難であった。診断確定および治療方針決定のため開腹腫瘍生検を施行し,免疫染色にてseminomaの診断となった。胚細胞腫瘍の国際的リスク分類に準じてbleomycin,etoposide,cisplatin(BEP療法)の化学療法を施行,その後精巣摘出術が行われた。PET-CTで後腹膜腫瘍の集積は,SUVmax値7.17から化学療法後に消失し著効した。術後7か月生存中である。