田金?肖雅楠?张腾龙?王洁?金材龙?郭成业

【摘要】绒毛膜癌是滋养细胞组织产生的恶性肿瘤。纯绒毛膜癌在睾丸中很少见，臨床上，多见青年患者，且常出现与转移扩散相关的症状，包括肺转移引起的咯血、腹膜后扩散引起的背痛、胃肠道出血和中枢神经系统受累引起的神经症状。该文报告一例46岁睾丸绒毛膜癌患者，以肺转移为首发症状，患者接受了放射治疗、化学治疗和免疫治疗，但治疗效果差，患者于确诊7个月后死亡。该例患者并非处于睾丸绒毛膜癌的高发年龄，病情进展极快，其诊治过程提示睾丸绒毛膜癌恶性程度高，临床特征是转移部位出血，患者预后差。临床医师应拓宽诊断思维，提高对罕见疾病的认识水平。

【关键词】男性;睾丸肿瘤;绒毛膜癌;肺转移;滋养细胞

Testicular choriocarcinoma： one case report Tian Jin， Xiao Yanan， Zhang Tenglong， Wang Jie， Jin Cailong， Guo Chengye. Department of Oncology， Qingdao Municipal Hospital Affiliated to Qingdao University， Qingdao 266000， China

Corresponding author， Guo Chengye， E-mail： chengye_guo@ qq. com

【Abstract】Choriocarcinoma is a malignant tumor derived from trophoblastic tissues. Pure choriocarcinoma is rarely seen in the testis. In clinical practice， it is more common in young patients， often manifested with symptoms related to metastasis and diffusion including hemoptysis caused by lung metastasis， back pain caused by retroperitoneal diffusion， gastrointestinal bleeding and neurological symptoms caused by central nervous system involvement. In this article， 1 male patient with pure testicular choriocarcinoma was reported. The initial symptom was lung metastasis. The patient received radiotherapy， chemotherapy and immunotherapy， but the treatment effect was poor. The patient died at 7 months after diagnosis. This patient was not aged in a high-risk period of testicular choriocarcinoma. The disease progressed at an extremely rapid speed. The diagnosis and treatment prompt that testicular choriocarcinoma is highly malignant， which is manifested with bleeding at the metastasis site and poor prognosis. Clinicians should broaden diagnostic thinking and deepen the understanding of this rare disease.

【Key words】Male;Testicular tumor;Choriocarcinoma;Lung metastasis;Trophoblast

绒毛膜癌占睾丸肿瘤的不到2%，睾丸绒毛膜癌在临床是非常罕见的，容易误诊。单纯性绒毛膜癌由于肿瘤细胞在早期经血行播散，多以肺和脑为靶器官，患者预后较差。笔者近年收治一例睾丸绒毛膜癌患者，患者为46岁男性，以咳痰带血丝为首发表现入院，经病理活组织检查（活检）及免疫组织化学染色检查（免疫组化）证实为纯绒毛膜癌，为提高临床医师对该病的认识水平，现将该例患者的诊治过程总结报告如下。

病例资料

一、病史及体格检查

患者男，46岁。2018年10月17日因查体发现肺占位3 d收入院。入院前3 d患者因“痰中带血丝”在即墨区第二人民医院行胸部CT检查，结果示双肺转移瘤并肺内感染，患者无胸痛、胸闷，无明显黄痰及发热盗汗史，未行治疗，后至青岛大学附属青岛市市立医院胸外科就诊，门诊拟“双肺多发结节”收入院。……