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Khatisong ena ea Clinical Difficulties, Bendu Konneh, BS, le basebetsi-'moho ba hlahisa nyeoe ea monna ea lilemo li 21 ea nang le histori ea likhoeli tsa 4 ea tsoelo-pele e nepahetseng ea testicular edema.
Monna ea lilemo li 21 o ile a tletleba ka ho ruruha ho tsoelang pele ha testicle e nepahetseng bakeng sa likhoeli tse 4.Ultrasound e ile ea senola boima bo sa tšoaneng bo tiileng ka har'a testicle e nepahetseng, pelaelo ea neoplasm e kotsi.Tlhahlobo e eketsehileng e ne e kenyelletsa computed tomography, e ileng ea senola 2 cm retroperitoneal lymph node, ho ne ho se na matšoao a sefuba sa metastase (setšoantšo sa 1).Matšoao a serum tumor a bonts'itse maemo a phahameng hanyane a alpha-fetoprotein (AFP) le maemo a tloaelehileng a lactate dehydrogenase (LDH) le gonadotropin ea chorionic ea motho (hCG).
Mokuli o ile a etsoa ka lehlakoreng le letona la inguinal orchiectomy.Tlhahlobo ea pathological e ile ea senola 1% ea teratoma e nang le likarolo tse ngata tse mpe tsa fetal rhabdomyosarcoma le chondrosarcoma.Ha ho tlhaselo ea lymphovascular e fumanoeng.Matšoao a phetoang a hlahala a bontšitse maemo a tloaelehileng a AFP, LDH le hCG.Litlhahlobo tsa morao-rao tsa CT ka nako e khuts'oane li netefalitse hore ho na le lymph node e kholo ea 2 cm interluminal aortic ntle le bopaki ba metastase e hole.Mokuli enoa o ile a etsoa retroperitoneal lymphadenectomy, e neng e le ntle ho 1 ea li-lymph nodes tse 24 tse nang le katoloso ea extranodal ea malignancy e tšoanang ea somatic e nang le rhabdomyosarcoma, chondrosarcoma, le spindle cell sarcoma e sa khethollang.Immunohistochemistry e bontšitse hore lisele tsa tumor li ne li le ntle bakeng sa myogenin le desmin le tse mpe bakeng sa SALL4 (Setšoantšo sa 2).
Testicular germ cell tumors (TGCTs) ke tsona tse ikarabellang bakeng sa liketsahalo tse phahameng ka ho fetisisa tsa kankere ea testicular ho banna ba bacha ba baholo.TGCT ke hlahala e tiileng e nang le li-subtypes tse ngata tsa histological tse ka fanang ka tlhahisoleseling bakeng sa taolo ea bongaka.1 TGCT e arotsoe ka mekhahlelo e 2: seminoma le non-seminoma.Li-nonseminomas li kenyelletsa choriocarcinoma, fetal carcinoma, yolk sac tumor, le teratoma.
Li-teratoma tsa testicular li arotsoe ka mefuta ea postpubertal le prepubertal.Prepubertal teratomas ha e sebetse ka tlhaho mme ha e amane le germ cell neoplasia in situ (GCNIS), empa teratoma ea postpubertal e amahanngoa le GCNIS 'me e kotsi.2 Ntle le moo, li-teratoma tsa postpubertal li na le ho hola ho ea libakeng tsa extragonadal joalo ka retroperitoneal lymph nodes.Ke ka seoelo, postpubertal testicular teratomas e ka fetohang mafu a somatic mme hangata a phekoloa ka opereishene.
Tlalehong ena, re fana ka tlhaloso ea limolek'hule tsa liketsahalo tse sa tloaelehang tsa teratoma e nang le karolo e kotsi ea somatic ho testes le lymph nodes.Ho tloha khale, TGCT e nang le malignancies a somatic e arabetse hampe mahlaseling a kotsi le chemotherapy e tloaelehileng e thehiloeng ho platinum, kahoo karabo ea A ha e nepahale.3,4 Boiteko ba ho shebana le chemotherapy ho fetotseng histology ho metastatic teratomas bo bile le liphetho tse fapaneng, 'me lithuto tse ling li bonts'a karabelo e ntle e tsitsitseng mme tse ling li sa bonts'e karabelo.5-7 Ha e le hantle, Alessia C. Donadio, MD, le basebetsi-'moho ba ile ba bontša likarabo ho bakuli ba kankere ba nang le subtype e le 'ngoe ea histological, ha re ntse re tseba li-subtypes tsa 3: rhabdomyosarcoma, chondrosarcoma, le spindle cell sarcoma e sa khetholloang.Ho hlokahala lithuto tse ling ho hlahloba karabelo ea chemotherapy e lebisitsoeng ho TGCT le somatic malignant histology ha ho etsoa metastasis, haholo-holo ho bakuli ba nang le mefuta e mengata ea histological subtypes.Ka hona, karabo ea B e fosahetse.
Ho lekola sebopeho sa mofets'e ona le ho tseba sepheo sa kalafo, re entse tlhahlobo ea "transcriptome tumor normal sequencing" (NGS) ho lipapiso tse bokelletsoeng ho tsoa ho bakuli ba nang le aortic lumenal lymph node metastases, hammoho le tatellano ea RNA.Tlhahlobo ea Transcriptome ka tatellano ea RNA e bonts'itse hore ERBB3 e ne e le eona feela lefutso le fetelletseng.Lefu la ERBB3, le fumanehang ho chromosome 12, li-code tsa HER3, receptor ea tyrosine kinase e atisang ho hlahisoa lera la lisele tsa epithelial.Liphetoho tsa Somatic ho ERBB3 li tlalehiloe ho tse ling tsa kankere ea mala le ea urothelial.robedi
Tekolo e thehiloeng ho NGS e na le phanele e tobaneng (xT panel 648) ea liphatsa tsa lefutso tse 648 tse atisang ho amahanngoa le mofetše o tiileng le oa mali.Panel xT 648 ha ea ka ea senola mefuta e fapaneng ea likokoana-hloko tsa pathogenic.Leha ho le joalo, mofuta oa KRAS missense (p.G12C) ho exon 2 e ile ea khetholloa e le eona feela phetoho ea somatic e nang le karolo e fapaneng ea allele ea 59.7%.Mofuta oa KRAS ke e 'ngoe ea litho tse tharo tsa lelapa la RAS oncogene le ikarabellang bakeng sa ho hokahanya mekhoa e mengata ea cellular e amanang le kholo le phapang ka pontšo ea GTPase.9
Le hoja liphetoho tsa KRAS G12C li atile haholo mofetšeng oa matšoafo oa sele e seng e nyane (NSCLC) le mofetše oa colorectal, liphetoho tsa KRAS le tsona li tlalehiloe ho TGCTs ea li-codon tse fapaneng.10,11 Taba ea hore KRAS G12C ke eona feela phetoho e fumanoang sehlopheng sena e fana ka maikutlo a hore phetoho ena e ka 'na ea e-ba eona e susumetsang ts'ebetso e mpe ea phetoho.Ho phaella moo, lintlha tsena li fana ka tsela e ka khonehang bakeng sa phekolo ea TGCTs e hanyetsanang le platinum e kang teratomas.Haufinyane tjena, sotorasib (Lumacras) e bile inhibitor ea pele ea KRAS G12C ho shebisa lihlahala tse fetotsoeng tsa KRAS G12C.Ka 2021, FDA e ile ea amohela sotorasib bakeng sa kalafo ea mofetše oa matšoafo oa sele e seng nyane.Ha ho na bopaki bo tšehetsang tšebeliso ea adjuvant translational histological targeted therapy bakeng sa TGCT e nang le karolo ea somatic malignant.Lithuto tse ling lia hlokahala ho lekola karabelo ea histology ea phetolelo ho kalafo e lebisitsoeng.Ka hona, karabo ea C e fosahetse.Leha ho le joalo, haeba bakuli ba e-ba le linako tse tšoanang tsa likarolo tsa 'mele, phekolo ea salvage e nang le sotorasib e ka fanoa ka bokhoni ba ho hlahloba.
Mabapi le matšoao a immunotherapy, lihlahala tsa microsatellite stable (MSS) li bontšitse boima ba phetoho (TMB) ea 3.7 m / MB (50th percentile).Kaha TGCT ha e na TMB e phahameng, ha ho makatse hore ebe nyeoe ena e le karolo ea 50 lekholong ha e bapisoa le lihlahala tse ling.12 Ha ho nahanoa ka boemo bo tlase ba TMB le MSS ea lihlahala, monyetla oa ho tsosa karabelo ea 'mele ea ho itšireletsa mafung oa fokotseha;Lihlahala li ka 'na tsa se ke tsa arabela kalafo ea immune checkpoint inhibitor.13,14 Ka hona, karabo E fosahetse.
Matšoao a serum tumor (STMs) a bohlokoa ho hlahloba TGCT;ba fana ka tlhahisoleseling bakeng sa sethala le stratification ea kotsi.Li-STM tse tloaelehileng tse sebelisoang hona joale bakeng sa tlhahlobo ea bongaka li kenyelletsa AFP, hCG, le LDH.Ka bomalimabe, katleho ea matšoao ana a mararo e lekanyelitsoe ho mefuta e meng ea TGCT, ho kenyelletsa teratoma le seminoma.15 Haufinyane tjena, li-microRNA tse 'maloa (miRNAs) li ngotsoe e le li-biomarker tse ka bang teng bakeng sa mefuta e meng ea TGCT.MiR-371a-3p e bonts'itsoe e na le bokhoni bo ntlafalitsoeng ba ho lemoha li-isoform tse ngata tsa TGCT tse nang le kutloelo-bohloko le boleng bo ikhethang ho tloha ho 80% ho isa ho 90% likhatisong tse ling.16 Leha liphetho tsena li tšepisa, miR-371a-3p hangata ha e phahame maemong a tloaelehileng a teratoma.Phuputso ea batho ba bangata ba Klaus-Peter Dieckmann, MD, le basebetsi-'moho e bontšitse hore sehlopheng sa banna ba 258, polelo ea miP-371a-3p e ne e le tlaase ka ho fetisisa ho bakuli ba nang le teratoma e hloekileng.17 Le hoja miR-371a-3p e sa sebetse hantle ho li-teratomas tse hloekileng, likarolo tsa phetoho e mpe tlas'a maemo ana li fana ka maikutlo a hore lipatlisiso li ka khoneha.Litlhahlobo tsa MiRNA li entsoe ka serum e nkiloeng ho bakuli pele le ka mor'a lymphadenectomy.Sepheo sa miR-371a-3p le mofuta oa referense oa miR-30b-5p li kenyelelitsoe tlhahlobisong.Polelo ea MiP-371a-3p e lekantsoe ke reverse transcription polymerase chain reaction.Liphetho li bonts'itse hore miP-371a-3p e fumanoe ka bongata bo fokolang ho lisampole tsa serum ea pele ho ts'ebetso le kamora ts'ebetso, ho bonts'a hore e ne e sa sebelisoe joalo ka lets'oao la hlahala ho mokuli enoa.Palo e bolelang ea potoloho ea lisampole tsa pele ho ts'ebetso e ne e le 36.56, 'me miP-371a-3p ha ea ka ea fumanoa ka lisampole tsa postoperative.
Mokuli ha aa ka a fumana phekolo ea adjuvant.Bakuli ba ile ba khetha ho lebela ka mafolofolo ka ho nka litšoantšo tsa sefuba, mpa, le pelvis joalokaha ho khothalelitsoe le STM.Ka hona, karabo e nepahetseng ke D. Selemo ka mor'a ho tlosoa ha li-lymph nodes tsa retroperitoneal, ho ne ho se na matšoao a ho khutlela mokhoeng oa lefu lena.
Tlhaloso: Sengoli ha se na thahasello ea lichelete kapa likamano tse ling le moetsi oa sehlahisoa leha e le sefe se boletsoeng sehloohong sena kapa mofani ofe kapa ofe oa litšebeletso.
Corresponding author: Aditya Bagrodia, Associate Professor, MDA, Department of Urology UC San Diego Suite 1-200, 9400 Campus Point DriveLa Jolla, CA 92037Bagrodia@health.ucsd.edu
Ben DuConnell, BS1.2, Austin J. Leonard, BA3, John T. Ruffin, PhD1, Jia Liwei, MD, PhD4, le Aditya Bagrodia, MD1.31 Lefapha la Urology, Univesithi ea Texas Southwestern Medical Center, Dallas, TX


Nako ea poso: Sep-23-2022