原発巣病理組織像が単一組織型セミノーマを呈しAFP高値を伴った非セミノーマ6例の臨床病理学的検討

摘要

Histologically pure seminoma with elevated alpha-fetoprotein (AFP), so-called AFP-positive seminoma, is rare. It is recommended that patients with AFP-positive seminoma be managed as non-seminoma5 but the clinical features and prognosis of this disease are not fully understood. In this study, we retrospectively analyzed 6 cases of metastatic AFP-positive seminoma at Tsukuba University Hospital (TUH). AFP was elevated before induction chemotherapy in 4 patients with an average of 1,372 ng/ml. In the remaining 2 patients, AFP became elevated during or after induction chemotherapy. In all4 patients examined, AFP-L3% was abnormally increased. As induction chemotherapy, all patients received bleomycin, etoposide and cisplatin (BEP)， which was then followed by etoposide, ifosfamide and cisplatin (VIP) in 3 patients. After or during induction chemotherapy, 3 patients suffered from disease progression accompanied by AFP elevation. All 3 were treated by salvage chemotherapy and surgery. Four patients underwent retroperitoneal lymph node dissection (RPLND) after induction chemotherapy ； the pathological findings were necrosis in 3 patients, and viable nonseminomatous cancer in 1 patient.