腎不全を契機に発見された精巣腫瘍

The testicular tumor presenting renal failure at first visit：a case report

42歳男性。右陰囊腫脹を自覚。2年後，両下肢浮腫で受診。血液検査で腎不全を示し，腹部CTで巨大な後腹膜リンパ節腫大と両側水腎症を認めた。透析後に両側腎瘻造設。右高位精巣摘除術を施行。組織型はセミノーマ，AFPは高値にて非セミノーマと診断。BEP3コース中，敗血症を繰り返した。3か月後の全腫瘍マーカーは正常化。1年後CTで残存腫瘤は1cm未満。後腹膜リンパ節郭清は行わず。5年間経過観察中で再発はない。

A 42-year-old man with the right scrotal swelling 2 years before, noticed bilateral leg edema. At his first visit, laboratory data showed renal failure. Abdominal CT revealed the huge retroperitoneal lymph-node metastasis resulting bilateral hydronephrosis. Hemodialysis was done, followed by bilateral percutaneous nephrostomy. Right orchiectomy, was performed and pathological diagnosis of the right testicular specimens showed pure seminoma. Our final diagnosis was non-seminoma, because of high serum alpha-fetoprotein（AFP）. The patient received 3 cycles of BEP chemotherapy, and after 3 months chemotherapy, all tumor markers decreased to normal limit. One year after chemotherapy, the retroperitoneal mass surrounding the large vessels decreased to less than 1cm. Retroperitoneal lymph-node dissection was avoided on the basis of risk-benefit. Five years after chemotherapy, no recurrence has been seen.