対側Wolff管発生障害を伴った進行性巨大精巣腫瘍

Giant seminoma with ipsilateral renal agenesis and colon metastasis：a case report

　症例は55歳男性。4年来の左陰囊内容腫大あるも医療保険未加入のため受診せず，下腿浮腫，食欲不振を生じて来院。精巣腫瘍の診断にて入院。左副腎，下行結腸転移と多発性リンパ節転移，左水腎症を認め，右腎尿管の欠損，膀胱三角部右側および右精囊の形成不全を認めた。高位除精術，内視鏡下結腸腫瘍生検を施行。病理組織学的に両者ともセミノーマと診断。術後後腹膜膿瘍，腸閉塞を発症し，化学療法を施行することなく死亡した。

A 55-year-old man presented with anorexia, edema and left scrotal swelling. He visited a medical institution 4 years after scrotal swelling because of medical insurance problems. CT revealed a huge testicular tumor, descending colon tumor, left adrenal tumor, multiple lymphnode swelling, left hydronephrosis, and agenesis of right seminal vesicle and kidney. The resected tumor weighed 3,200 g was pathologically diagnosed as seminoma. Cystoscopic examination revealed hypoplasia of the right side trigone with absence of ureteral orfice. The colon tumor biopsied was pathologically diagnosed as seminoma. Thus, the testicular tumor was diagnosed as pT4N3M1 seminoma. One month after orchiectomy, ileus occurred. The patient died 16 days after the operation.

This is the fourth case of seminoma with renal agenesis reported in the literature in Japan.