Departmental Bulletin Paper 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
A Clinicopathologic Study of 6 Patients with Histologically Pure Seminoma But Elevated Serum Alpha-Fetoprotein

神鳥, 周也  ,  河合, 弘二  ,  田中, 建  ,  河原, 貴史  ,  池田, 篤史  ,  石塚, 竜太郎  ,  木村, 友和  ,  小島, 崇宏  ,  常楽, 晃  ,  宮崎, 淳  ,  西山, 博之

63 ( 4 )  , pp.139 - 143 , 2017-04-30 , 泌尿器科紀要刊行会
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-seminoma, 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 all 4 patients examined, AFPL3% 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. Furthermore, RPLND was performed as salvage surgery in 3 patients ; the pathological findings were necrosis, viable nonseminomatous cancer and teratoma with malignant transformation, respectively. The 5-year progression-free survival rate of the 6 patients was 50%, which is somewhat inferior to that of poor-prognosis non-seminoma patients treated at TUH. One patient ultimately died of cancer, and the remaining 5 are in remission with a median follow-up of 58 months. The present study demonstrates that AFP-positive seminoma patients have a higher risk of relapse compared to non-seminoma patients.

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