目的 探讨睾丸原发性绒毛膜上皮癌伴未成熟畸胎瘤的病理学特点及诊治方法.方法 对2011-10-08入我院治疗的1例男性原发性绒毛膜上皮癌伴未成熟畸胎瘤患者进行病理组织检查(巨检、镜检、免疫组织化学检查),并结合文献分析国内外报道该病例的病理学特点、临床表现、鉴别诊断及治疗与预后.结果 病理巨检:睾丸内可见肿瘤大小6 cm×4 cm×4 cm,切面实性,灰红,灰白,质地中等,与周围组织界限清.病理镜检:镜下可见在大量出血、坏死的背景中排列成不同结构的瘤细胞,部分为合体滋养层细胞,部分为细胞滋养层细胞,另一部分由数量不等的未成熟的胚胎组织构成.免疫组织化学检查:滋养叶细胞阳性,人绒毛膜促性腺激素(HCG)阳性,细胞角蛋白(CK)阳性,甲胎蛋白(AFP)阳性,胶质纤维酸性蛋白(GFAP)灶阳性,胎盘碱性磷酸酶(PLAP)阴性.病理诊断:睾丸原发性绒毛膜上皮癌伴未成熟畸胎瘤.治疗与预后:患者行根治性睾丸切除术,术后进行化疗和放疗,化疗采用顺铂+博莱+VT16,临床有一定的疗效;随诊9个月,患者一般状况良好,肺转移灶缩小,腹膜后肿瘤无改变.结论 睾丸原发性绒毛膜上皮癌伴未成熟畸胎瘤临床少见,临床治疗倾向于手术切除+化疗综合治疗,预后较差,诊断时应多取材.%Objective To discuss the pathological characteristics and diagnosis and treatment of primary chorionepithelioma with immature teratoma of testis. Methods A case of primary chorionepithelioma with immature teratoma of testis admitted to our hospital on October 8 , 2011 was given histopathology examination, including gross observation, microscopy and immuno-histochemistry examination. By referring to literatures at home and abroad, the pathology characteristics, clinical manifestation, antidiastole, treatment and prognosis of the case were analyzed. Results Gross observation: the tumor were 6 cm × 4 cm × 4 cm in size in testis, and the tumor were solid in section, grey, red, medium in nature and clear with the surrounding tissues. Microscopy: the tumor cell at micro was variegated, one part was made up of the syncytiotrophoblast and cytotrophoblast cells at the background of extensive hemorrage and necrosis; the other part was composed of a few immature embryo tissues. Immunohistochemisty: trophoblastic cell ( + ), HCG ( + ), CK ( + ), AFP ( + ), GFAP ( + ), PLAP ( - ). Pathologic diagnosis: primary chorionepithelioma with immature teratoma of testis. Treatment and prognosis: the patient was treated by radical testectomy, and was given radiation and chemotherapy after operation. The chemotherapeutic drug were cisplatin, bleomycin and VT16. During the nine months following up, the patient was in a healthy state: the lung metastasis was reduced and the retroperitoneal tumor had no change. Conclusion The occurrence of primary chorionepithelioma with immature teratoma of testis is rare, and the treatment in clinic is usually exairesis and chemotherapy with bad prognosis, thus more materials should be drawn from the organization on diagnosis.
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