精巣部分切除と局所放射線照射を施行した異時性両側精巣腫瘍

A case of metachronous bilateral testicular tumor treated by partial orchiectomy and local radiation

患者は33歳時に右精巣腫瘍の診断（精上皮腫stage Ⅰ）で高位除睾術施行をした男性。術後2年で左陰囊内硬結を認め，異時性両側精巣腫瘍の診断となった。精巣温存を希望し，精巣部分切除と腫瘍床生検を施行した。術中迅速診断で腫瘍床に悪性細胞はなかったが，永久標本でcarcinoma in situ（CIS）を認めた。術後局所放射線療法を施行した（20Gy/10回）。治療後6か月での精子数は0/mlであったが，血中テストステロン値は正常下限で推移しており，6年の経過で再発なく勃起機能・射精能を維持している。

A 35-year-old man, with a history of right orchiectomy for stage Ⅰ seminoma 2 years ago, found the induration at his left scrotum. MRI showed a tumor 20 mm in diameter within the left testis. Partial orchiectomy and biopsy of the tumor bed were performed. The pathological finding of the tumor was pure seminoma, and carcinoma in situ of tumor bed. We recommended inguinal orchiectomy or chemotherapy or local radiation as an additional therapy. Since he had already two children, he selected to preserve serum testosterone level, but not the fertility. He received local radiation with 20 Gy. Although he became infertile due to local radiation therapy, he is alive without recurrence for 6 years after surgery, and does not need androgen substitution.