精索惡性纖維組織細胞瘤病例報告

Malignant Fibrous Histiocytoma of Spermatic Cord: A Case Report

我們報告一位65歲男性罹患精索惡性纖維組織細胞瘤的病例。病患因左側陰囊無痛性腫塊歷6個月之久求診，臨床檢查未發現腹股溝淋巴腺病變，病患亦無生殖系統惡性腫瘤家族病史。病患接受左側腹股溝性腺根除手術，檢體經目視為左側精索腫瘤單一腫塊，組織病理學及免疫組織化學染色檢查確診為高惡性度之惡性纖維組織細胞瘤。病患於手術後亦接受放射治療。病患於確診25個月之後因左側腹股溝腫瘤復發再次接受手術及放射治療。病患於確診45個月之後因兩側腹股溝腫瘤再度復發合併兩側肺部轉移而病故。本文主要基於組織病理學與免疫組織化學染色檢查之觀點，對於精索惡性纖維組織細胞瘤此一罕見腫瘤做鑑別診斷。另外於文獻回顧發現精索惡性纖維組織細胞瘤，若最初症狀為單一腫塊，則較之人體其他部位同類腫瘤，具有比較緩慢之臨床病程，預後較好。若最初症狀為多發性衛星型腫塊，則容易復發及轉移，預後不佳。

We report a case of malignant fibrous histiocytoma (MFH) of left spermatic cord in a 65-year-old man. The patient presented with a 6-month history of a growing, painless left scrotal mass. He received left radical orchiectomy under the diagnosis of testicular tumor. Grossly, the specimen showed a solitary spermatic cord tumor without satellite nodules. Histopathologically, the sections of tumor revealed a high-grade storiform-pleomorphic MFH. Post-operative radiation therapy was performed. Twenty-five months later he experienced local recurrence and then underwent surgery and radiotherapy. The sections of recurrent tumor were morphologically similar to the original lesion. Finally, bilateral lungs metastases developed and he died 45 months after the initial diagnosis. The differential diagnosis for spermatic cord MFH based on the histopathology and immunohistochemistry as well as the clinical features of this rare tumor are demonstrated.