摘要目的 探讨精母细胞型精原细胞瘤的临床病理特征及生物学行为.方法 收集中国医科大学附属盛京医院病理科2003年1月至2011年5月间病理诊断为睾丸精原细胞瘤68例,精母细胞型精原细胞瘤3例.分析患者临床资料,进行HE及免疫组织化学SP法染色,并对患者进行随访.结果 经复查,确认66例为睾丸精原细胞瘤,5例为精母细胞型精原细胞瘤.这5例患者年龄平均53岁,均为临床Ⅰ期,无隐睾史,不伴其他生殖细胞肿瘤,免疫组织化学示CK、波形蛋白、OCT3/4、胎盘碱性磷酸酶(PLAP)等均阴性,PAS糖原染色亦阴性；1例示CD117散在阴性,其余4例CD117阴性.术后11个月至6年无1例复发或转移.66例睾丸精原细胞瘤患者平均年龄37岁,约12％伴隐睾,约11％是临床Ⅱ期.免疫组织化学表现为PLAP和OCT3/4全部阳性,69.6％(32/46)CD117阳性.随访时间 1至9年,随访的28例Ⅰ期患者中,有2例复发,1例死亡,Ⅱ期3例患者中1例死亡.结论 精母细胞型精原细胞瘤不同于精原细胞瘤,是一少见的、独特的有低转移潜能的临床病理类型,由于它很少发生转移或肉瘤样分化,并具有良好的预后,在睾丸切除术后,可不需进一步处理,为避免过度治疗,正确的组织学诊断非常重要.

abstractsObjective To study the cinicopathologic features and biological behavior of spermatocytic seminoma.Methods A retrospective analysis of patients diagnosed as seminoma,spermatocytic seminoma between January 2003 and May 2011,was performed.Clinical data,HE stained section and immunohistochemical staining (SP method) were reviewed with follow-up.Results Sixty-six cases of seminoma and 5 cases of spermatocytic seminoma were identified.The average age at the diagnosis of 5 cases of spermatocytic seminoma was 53 years,and no patient had a history of crytorchidism or germ cell tumor.All five patients had stage pT1 tumor.Immunohistochemical studies showed that spermatocytic seminoma was negative for CK,vimentin,OCT3/4,PLAP,and LCA,and PAS staining was also negative.All five patients were well after operation.In contrast,the average age at diagnosis of the 66 cases of seminoma was 37 years,in which 12％ had a history of crytorchidism and 11％ were in stage pT2 or the above.Immunohistochemical studies showed that seminoma was positive for OCT3/4,PLAP,and CD117.During the follow-up,2 patients developed metastasis and 3 patients died of the disease.Conclusions Spermatocytic seminoma is rare and appears to follow a benign clinical course Due to its favourable prognosis,further treatment is not necessary after orchidectomy.Accurate pathologic diagnosis is critical for patient management and for avoiding over-treatment.