精巣胚細胞腫瘍由来の発症が示唆された急性骨髄性白血病  [in Japanese] Acute myeloid leukemia possibly originating from the same clone of testicular germ cell tumor  [in Japanese]

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Abstract

症例は30歳男性。26歳時に精巣悪性混合型胚細胞腫瘍を発症。手術・化学療法が施行され,経過観察されていた。胚細胞腫瘍発症から4年後,汎血球減少,LDH上昇が出現し,血液内科に紹介。骨髄のライト・ギムザ染色では芽球様細胞が95%以上を占めており,これらの細胞はミエロペルオキシダーゼ(MPO)染色陰性であった。病理学的には急性骨髄性白血病(AML)に矛盾しなかった。フローサイトメトリーでは大部分がCD45-CD34+CD13+であった。骨髄・精巣腫瘍検体を用いたfluorescence <i>in situ</i> hybridization法にて,両検体で第12染色体短腕領域の増幅を認めた。AMLに準じた寛解導入療法により寛解を得たのち,地固め療法に続いてHLA一致同胞より同種造血幹細胞移植を施行した。移植後1年以上血液学的寛解を維持し,精巣腫瘍の再発も認めていない。本症例の骨髄腫瘍は,FISH検査にて類似の異常を認めることから精巣胚細胞性腫瘍と共通起源を持つ細胞に由来し,AMLとほぼ同様の病態を呈したものと考えられる。

This report describes a 30-year-old man with a testicular germ cell tumor, which later developed into acute myeloid leukemia (AML) with a common chromosomal abnormality. Testicular germ cell tumors had developed at the age of 26. He was successfully treated with surgery followed by chemotherapy.<br>Four years after the onset of the germ cell tumor, he developed pancytopenia with elevated serum LDH. More than 95% of the bone marrow was occupied by blastic cells. These cells were CD13+, CD34+ but CD45- and MPO-. Amplification of the short arm of chromosome 12 was recognized by fluorescence <i>in situ</i> hybridization using the blastic cells in the bone marrow and the previous testicular tumor specimen. Because testicular germ cell tumor recurrence and other malignant tumors could be ruled out pathologically, he was diagnosed as having AML.<br>Allogeneic stem cell transplantation from a HLA-matched sibling donor was performed after chemotherapy. As of 19 months after the transplantation, recurrence of neither AML nor testicular tumors has been observed. Because the same genetic abnormality was observed in the testicular germ cell tumor and AML in this case, the possibility of AML having a common origin with the testicular germ cell tumor is indicated.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 54(8), 764-768, 2013-08-30

    The Japanese Society of Hematology

References:  14

Codes

  • NII Article ID (NAID)
    10031196294
  • NII NACSIS-CAT ID (NCID)
    AN00252940
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    04851439
  • NDL Article ID
    024852527
  • NDL Call No.
    Z19-295
  • Data Source
    CJP  NDL  J-STAGE 
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