左鼠蹊部停留睾丸に発生せるSeminomに就て

抄録

Seminoma is a malignant tumour exclusively found in testicle, which was denominated by Chevassu in 1906. However, at that time, it was reported as a testicular tumour of large cells, This denomination by Chevassu was based on the theory that this tumour is originated from the epithelium of the convoluted seminiferous tubules. Nevertheless, even at present, some claim that this is a tumour of epithelial origin, and some claim that this is a sarcoma, thus no conclusive theory has yet been reached. Resently, authors happened to attend a case of 34 years old suffering from undescended testicle in the left inguinal region accompanied by this tumour, and had the opportunity to observe clinically and to perform pathological and histological examinations on the enucleated testicle. The present paper reports the results of the above findings and discussions
Pathological and Histological Findings.
The parenchyma of the tumour is encapsulated by connective tissue membrane, and further separated into cellular masses of various irregular shapes and sizes by septa The relationship between the cells and interstitial tissue is generally irregular and they are intermingled forming cellular masses of various sizes. The cells of the tumour is combined in a complicated picture. In certain portion, the tumour is consisted of gatherings of small cavities, the walls of which is covered by endothelial cells or reticuloid cells with small rodshaped nuclei. In certain other portion of the tumour, cells suggesting of syncytium are observed. However, the major part of the tumour is consisted of large epithelial polygonal cells, weakly stained nuclei are seen in a fairly large number of the cells. The interstitium is infiltrated by small round cells, which are loosely separated by a substance to be called “lymphatic stroma”. This is one of the characteristics of this tumor.In view of the above findings, this tumour is considered to be a seminoma with the characters of mixed tumor to large extent.
Clinical Symptoms.
The plincipal c inical symptoms are relatively chronic swelling and sense of opression. In most cases of the age in which the patients have perfect sexual ability, it occurs in the right testicle. However, this case occurred in the left testicle.
This tumor is believed to be originated from the stem cells related to the semen production. Since the stem cells are undifferentiated cells, in case the proliferation of such stem cells occurred, the formation of teratoma or mixed tumour, which contains tissues developed from three germ layers, is considered quite probable. Specifically in the cases of seminoma, a good number of the cases shows the characters of mixed tumour demonstrating various histological pictures in one same specimen. Each case develops to a particular direction showing a specific histological picture. The above are the descriptions by various workers in the past. Chorion epithelioma is one of them, which was reported by Friedlander and Takano. Beside the above, myoma, fibroma, mixoma and chondroma are recognized as complications of this tumour. As to the so-called primary genital stem cell theory, no decisive conclusions have yet been reached. Stieve claimed that the tumour is originated from endodermic wandering cells rather than from the pre-stage of seminal epithelial cells.
As for the treatment for this case, due to the proximate cause (undescended testicle in this case) and unfavorable prognosis, early enucleation of testicle and inguinal lymphnodes combined with X-ray treatment is considered to be rational and adequate.