石棉暴露与睾丸阴道膜恶性间皮瘤:病例系列及文献回顾

C. Meisenkothen, M. Finkelstein
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引用次数: 7

摘要

在正常的人类胚胎发育过程中,睾丸从腹腔下降到阴囊。阴道通过阴道突,在妊娠第3个月开始时出现腹膜壁突。当睾丸进入阴囊后(妊娠7 - 9个月),阴道突通常消失。然而,在20%的人口中,出生时阴道突仍未愈合。大多数患有阴道突未闭的男孩一生中都没有症状,但阴道突不完全闭合可能导致各种异常。完全通畅可导致沟通性鞘膜积液或先天性阴囊疝。持续的阴道突通常在出生后的第一年关闭,可能是对通常发生在1-2个月大的血清睾酮激增的反应。阴道膜是由阴道突上部闭合形成的间皮囊。如果阴道突没有完全闭合,那么阴道膜仍然与腹膜腔相连。摘要阴道膜间皮瘤是一种罕见的肿瘤。在荷兰的一项间皮瘤病例研究中,大多数间皮瘤发生在胸膜,其中119例(88%)对15例(11%)在腹膜,2例在阴道睾丸膜2。Marinaccio及其同事在意大利国家间皮瘤登记处报道了胸膜外间皮瘤的发病率。标准化发病率(意大利,2004年,每百万居民)腹膜部位为2.1例,阴道睾丸膜为0.2例。在英国健康与安全执行局的间皮瘤登记中,阴道膜间皮瘤仅占所有间皮瘤死亡病例的0.09%(10例)。阴道膜间皮瘤与接触石棉有关。第一份病例报告由Fligiel和Kaneko于1975年发表。研究对象是一名68岁的男子,从事管道绝缘子工作已有40年。Gorini和他在意大利的同事报告了两例这种肿瘤。一名67岁男子因职业接触石棉长达30年,潜伏期为42年。1例80岁男性接触石棉5年,潜伏期52年。spess和他的同事报道了一项回顾性的临床病理和随访研究,研究对象是在德克萨斯州休斯顿的M.D.安德森癌症中心治疗的5例恶性阴道膜间皮瘤患者,研究时间长达25年。5名患者中有4人暴露于石棉。在意大利登记研究中,70%的阴道膜间皮瘤患者曾因职业或休闲接触石棉。对于有足够信息的病例,估计平均潜伏期(定义为从开始接触石棉到诊断之间的时间)为46.8年*通讯作者:cmeisenkothen@elslaw.com
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: Case series and review of the literature
Introduction During normal human embryonic development, the testes descend from the abdominal cavity to the scrotal sac. Passage occurs through the processus vaginalis, which arises as an outpouching of the parietal peritoneum at the beginning of the third month of gestation. After the testis descends into the scrotum (between 7 and 9 months of gestation), the processus vaginalis is normally obliterated. However, the processus vaginalis remains patent at birth in 20% of the population. Most boys born with a patent processus vaginalis remain asymptomatic throughout life, but incomplete closure of the processus vaginalis may lead to a variety of abnormalities. Complete patency may result in a communicating hydrocele or a congenital i nguinoscrotal hernia. A persistent processus vaginalis often closes during the first year of life, probably in response to the surge in serum testosterone that normally occurs at 1–2 months of age1. The tunica vaginalis is a mesotheliumlined sac that results from closure of the superior portion of the processus vaginalis. In the event that the processus vaginalis does not close completely, then the tunica vaginalis remains in communication with the peritoneal cavity. Mesothelioma of the tunica vaginalis is a rare tumour. In a study of incident cases of mesothelioma in the Netherlands, most of the mesotheliomas occurred in the pleura, where there were 119 (88%) against 15 (11%) in the peritoneum and two in the tunica vaginalis testis2. Marinaccio and colleagues3 reported on the incidence of extrapleural mesothelioma in the Italian National Mesothelioma Registry. Standardized incidence rates (Italy, 2004, per million inhabitants) were 2.1 cases for the peritoneal site and 0.2 cases for the tunica vaginalis testis. Mesothelioma of the tunica vaginalis represents only 0.09% (10 cases) of all mesothelioma deaths in the UK Health and Safety Executive Mesothelioma Register4. Mesothelioma of the tunica vaginalis has been associated with asbestos exposure. The first case report was published by Fligiel and Kaneko in 19765. The subject, a 68-year-old man, had worked for 40 years as a pipe insulator. Gorini and colleagues6 in Italy reported two cases of this tumour. A 67-year-old man had been occupationally exposed to asbestos for a 30-year period with a latency of 42 years. An 80-year-old man had been exposed to asbestos for 5 years with a latency of 52 years. Spiess and colleagues reported a retrospective clinicopathological and follow-up study of five patients with malignant mesothelioma of the tunica vaginalis treated at the M.D. Anderson Cancer Center in Houston, Texas, during a 25year period7. Asbestos exposure was identified in four of the five patients. In the Italian Registry Study3, 70% of subjects with mesothelioma of the tunica vaginalis had occupational or leisure-related exposure to asbestos. Mean latency (defined as the time elapsing between the beginning of exposure to asbestos and diagnosis) was estimated for cases with sufficient information and was 46.8 years * Corresponding author Email: cmeisenkothen@elslaw.com
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