Poor prognosis of retroperitoneal mixed extragonadal germ cell tumors in an HIV-infected man with severe immunosuppression and bilateral cryptorchidism: a case report
Poor prognosis of retroperitoneal mixed extragonadal germ cell tumors in an HIV-infected man with severe immunosuppression and bilateral cryptorchidism: a case report
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患有严重免疫抑制和双侧隐睾的 HIV 感染者腹膜后混合性性腺外生殖细胞肿瘤预后不良：一例报告
DOI：
10.1186/s12885-019-5456-0
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发表时间：
2019-03-18
期刊：
影响因子：
3.8
通讯作者：
Li，Hongjun
中科院分区：
文献类型：
--
作者：
Li，Ruili;Li，Hongjun
背景非精原细胞生殖细胞肿瘤（NSGCT）是生殖细胞肿瘤（GCT）的主要类别之一，并且它们比精原细胞肿瘤更具侵袭性。人类免疫缺陷病毒（HIV）阳性被认为是睾丸精原细胞瘤患者的危险因素，但有关 HIV 感染者发生 NSGCT 的报道很少。 病例介绍我们报告一例腹膜后混合性性腺外生殖细胞肿瘤病例，患者为 HIV 感染者，自出生起就被诊断为双侧隐睾。一名30岁男性，腹部超声检查发现右下腹有一个大的不均匀混合回声肿块；他是HIV阳性，在随后的检查中CD4计数低至70个细胞/毫升，这表明存在严重的免疫抑制，超声引导下的活检组织学显示睾丸存在恶性卵黄囊肿瘤。首先，患者接受联合抗逆转录病毒治疗；随后为缓解症状，在全身麻醉下进行剖腹探查及腹膜后肿瘤切除术进行后续治疗。术后组织病理学检查提示患者未降睾呈恶性混合性GCT，以卵黄囊肿瘤为主，病灶为胚胎细胞癌和精原细胞瘤；它是各种 GCT 中罕见的类型，尤其是 HIV 感染者。术后1周、2周进行CT随访扫描，结果显示右侧腹股沟肿块逐渐增大，提示预后不佳。为了限制肿瘤的生长，初次手术17天后在局麻下进行了右侧腹股沟肿块切除术，病理检查发现混合性GCT转移。随后，患者接受了顺铂、依托泊苷和异环磷酰胺方案的挽救性化疗。不幸的是，患者在第一个周期化疗后1周因严重的免疫抑制、血小板计数低和癌症恶病质而死亡。结论由于严重的免疫抑制，晚期性腺外NSGCT对HIV感染者的治疗导致预后不良。应在进一步的研究中考虑这一结果，并需要建立适当的管理以实现长期生存。
BackgroundNonseminomatous germ cell tumors (NSGCTs) represent one of the main groups of germ cell tumors (GCTs), and they have a more invasive course than seminomatous GCTs. Human immunodeficiency virus (HIV) positivity is considered to be a risk factor for testicular seminoma patients, but reports about HIV-infected individuals with NSGCTs are rare.Case presentationWe report a case of a retroperitoneal mixed extragonadal germ cell tumor in an HIV-infected man who has been diagnosed with bilateral cryptorchidism since birth. A 30-year-old man presented with a large heterogeneously mixed echo mass located in the right lower abdomen according to an abdominal ultrasound; he was HIV-positive and had a low CD4 count of 70 cells/ml in the followed test, which suggested severe immunosuppression, and ultrasound-guided biopsy histology revealed a malignant yolk sac tumor of the testis. First, the patient received combination antiretroviral therapy; then, to relieve his symptoms, an exploratory laparotomy and retroperitoneal neoplasm resection under general anesthesia were performed for subsequent treatment. The postoperative histopathological examination indicated that the patient exhibited malignant mixed GCTs of the undescended testis that were composed predominantly of yolk sac tumors with foci of embryonal cell carcinoma and seminoma; It is a rare type in various GCTs, especially in HIV-infected patients. After the operation, the patient underwent computed tomography follow-up scans at 1 week and 2 weeks, and the results showed that the size of the right inguinal mass gradually increased, which suggested a poor outcome. To limit the growth of the tumors, right inguinal mass resection under local anesthesia was performed 17 days after the initial operation, and pathological examination revealed mixed GCT metastasis. Subsequently, the patient received salvage chemotherapy with a regimen of cisplatin, etoposide, and ifosfamide. Unfortunately, the patient died 1 week after the first cycle of chemotherapy because of severe immunosuppression, a low platelet count and cancer cachexia.ConclusionsBecause of severe immunosuppression, the treatment of advanced extragonadal NSGCTs in an HIV-infected patient resulted in a poor prognosis. This outcome should be considered in further research, and appropriate management for achieving long-term survival needs to be established.