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中華民國泌尿科醫學會雜誌

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篇名 Aggressive Treatment of Testicular Choriocarcinoma with Lung Metastasis and Pulmonary Hemorrhage
卷期 11:1
並列篇名 睪丸絨毛膜細胞癌併肺轉移及肺出血的積極性治療
作者 陳嘉鴻楊文宏蔡宗欣蔡育賢何中良唐一清
頁次 018-022
關鍵字 絨毛膜細胞癌睪丸腫瘤ChoriocarcinomTesticular neoplasmTSCI
出刊日期 200003

中文摘要

在睪丸腫瘤中絨毛膜細胞癌是愈後相當惡性及罕見的一種。從西元1988到1999年,我們總共發現三個病例。病人的年齡分別為26,25及17歲。第一個病例是單純絨毛膜細胞癌,另外兩個病例則屬於混合型(畸胎瘤及絨毛膜細胞癌,精細胞瘤及絨毛瘤細胞癌)。所有的病人最初表現都為睪丸腫大,乙型人類絨毛膜生殖激素(B-hCG)上升及都有絨毛膜細胞癌症狀(choriocarcinoma syndrome)。所有的病人因為肺轉移及持續性出血,於一星期內死亡。另一位病人三個月後,因為化學治療引起的骨髓功能抑制及肺毒性,併發敗血症及咳血後而死亡。第三位病人曾在血胸時,接受過部分肺葉切除以止血,且在六次的化學治療後,乙型人類絨毛膜生殖激素(B-hCG)下降到測量不到的程度(小於1mIU/ml),至今存活了10個月。接下來此病人將接受手術探查,以了解殘餘腫瘤病理組織型態,作為往後治療的參考。早期肺部轉移合併致命大量肺部出血,以致無法接受化學治療,是病人早期治療失敗,甚至死亡的原因。我們報告三個病例的經驗並且回顧文獻。

英文摘要

Choriocarcinoma is not common and is frequently associated with a poor prognosis among testicular tumos. From 1988to1999, three cases of testicular choriocarcinoma were found in our hospital. The ages of all 3 patients were in the second or third decades. One case was pure choriocarcinoma;the other 2 were of mixed types(teratoma with choriocarcinoma and seminoma with choriocarcinoma, respectively). All 3 patients had a markedly enlarged testicular mass with elevated beta-human chorionic gonadotropin(B-hCG)at onset and fulfilled the definition of choriocarcinoma. syndrome. Two were suffering from hemothorax initially. All 3 patients recaived cisplatin-based chemotherapy after radical orchiectomy. One patient died of respiratory failure and hemothorax resulting from pulmonary metastases within l wk after treatment. Another patient died of septic shock, hemoptysis 3 mo after therapy because of both myelosuppressive and pulmonary toxicity from chemotherapeutic agents. The third case is still alive after a total of 6 courses of cisplatin-based chemotherapy and after receiving palliative pulmonary wedge resection for active hemorrhage. Despite some residual pulmonary and retroperitoneal nodules, the serum s-hCG level declined from more than 5000 mIU/ml to an undetectable level after chemotherapy. Subsequent surgical intervention of residual pulmonary or retroperitoneal nodules, for histology will be done. From our experience, early pulmonary metastases with fatal pulmonary hemorrhage in patients with choriocarcinoma contributed to treatment failure, even to death. We present our experience and review the literature.

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