精巣腫瘍患者の非腫瘍側精巣にみられた超音波断層法による精巣内微小石灰化症とCarcinoma in situの関連性について  [in Japanese] RELEVANCE OF TESTICULAR MICROLITHIASIS TO THE TESTICULAR CARCINOMA IN SITU IN THE CONTRALATERAL TESTICLE  [in Japanese]

(目的)精巣腫瘍患者の非腫瘍側精巣の超音波断層法上の精巣内微小石灰化症(TM)の存在とCarcinoma in situ (CIS)の関連性について検討した.(対象と方法)1993年10月から2005年6月までに片側性精巣腫瘍の診断で術前に超音波検査を施行され,高位精巣摘除術と対側精巣生検を施行した41例(平均年齢 34.6歳)を対象とした.非腫瘍側精巣の超音波断層像を再評価し,TMの有無を検討した.保存精巣生検組織を使用し,HE染色およびplacental alkaline phosphatase (PLAP)免疫染色を行い,CISの有無について検討を行った.TMを有する症例では問診と超音波検査で経過観察を行った.(結果)41症例中11例(26.8%)に超音波断層法上TMを認め,TMを認めた11例中2例に病理組織学的に微小石灰化を確認できた.TM11症例中2例(18.2%)にCISがみられたが,非TM症例30例ではCISはみられなかった(p=0.017).経過観察期間中TM症例(平均観察期間37.3月,3〜85ヵ月)および非TM症例(平均観察期間50.9月)とも精巣腫瘍の発生はみられなかった.(結論)片側精巣腫瘍の対側精巣にTMは高頻度にみられ,非腫瘍側精巣のTMの存在は非腫瘍側精巣のCIS出現との関連性が示唆された.

(Purpose) To determine the prevalence of testicular microlithlasis (TM) in the contralateral testis of patients with unilateral testicular tumor, and evaluate the association of TM with carcinoma in situ (CIS) (Materials and Methods) In a period of 12 years, ultrasonography was performed in 41 patients with unilateral testicular tumor. TM was defined as multiple small hyperechogenic foci. Only images of the tumor-free testis were reviewed. In addition, archived biopsy specimens of the contralateral testicle were reviewed after immunostaining for placental alkaline phosphatase (FLAP) as a marker for CIS. (Results) TM was diagnosed in 11 (26.8%) patients. Of them, microliths were pathologically confirmed in only 2. Prevalence of CIS was higher in patients with TM (2 of 11 patients) than in those without TM (0 of 30 patients, p=0.017) (Conclusion) TM was associated with testicular tumor. TM in the contralateral testis of patients with unilateral testicular tumor may increase the risk of CIS.