| Objective:To study the clinical features of different pathological types of testicular malignancies and the influence of each clinical feature on prognosis,and provide clinical reference for the diagnosis and treatment of different pathological types of testicular malignant tumors.Method:Collecting the clinical data of patients diagnosed with testicular malignant tumor from April 2013 to October 2021 in the First Hospital of Jilin University and drawing three-line tables to analyze and summarize the age distribution characteristics,ultrasound characteristics,tumor maker characteristics,adverse reactions of radiotherapy and chemotherapy,and pathological types of cryptorchidism in different pathological types of testicular malignant tumors.SPSS 26.0 was used for statistical analysis,and Kaplan-Meier Survival analysis charts and log-rank test was used to compare the cumulative mortality of patients with different clinical characteristics.Statistically significant indicators were screened for further COX multivariate regression analysis.The test level is P<0.05,which is statistically significant.Results:A total of 154 patients with testicular malignancies were collected,including 89 seminoma,28 mixed germ cell tumor,10 embryonal carcinoma,1 choriocarcinoma,and 26 primary testicular lymphoma.75 cases of left side,78 cases of right side,1case of bilateral side;122 cases of stage I,22 cases of stage II,6 cases of stage III,4cases of stage IV.1、In the study on age,the overall age of the patient population ranged from 17 to 86 years,with a mean of 51.5 years.（1）There were no patients younger than 10 years old in each group.（2）In the seminoma group and the mixed germ cell tumor group,the largest number of people were in the age group of 30-39 years;accounting for 38.2% and 46.4% of the total population in each group;embryonal carcinoma patients were all between aged 20-39 years old;there was only one patient with choriocarcinoma,33 years old.（3）In the primary testicular lymphoma group（PTL）,patients over the age of 50 accounted for 92.3%.2、In terms of ultrasound manifestations,（1）the most common types of testicular tumors are enlarged;（2）except for mixed germ cell tumors,other types of testicular malignant tumors are mostly hypoechoic;（3）seminoma,mixed germ cell tumors,embryonal carcinomas,and choriocarcinomas are mostly solitary,and PTLs are mostly diffuse;（4）Almost all pathological types of tumors are solid tumors;（5）Except for choriocarcinoma,there is a small amount of blood flow In addition,other types of tumors mostly show abundant blood flow.3、（1）In seminoma,about 30% of patients had elevated HCG or LDH,and 7.8%of patients had elevated AFP;（2）in non-seminoma,66.7% of patients had elevated AFP,and 59.0% of patients had elevated HCG,and 43.6% of patients had elevated LDH;（3）In PTL,57.7% of patients had elevated LDH,3.8% of patients had elevated AFP,and no patients with elevated HCG.4 、（1）In terms of the color of the tumor section,the most common tumor sections of each pathological type are light brown;（2）In terms of nature,the tumor sections of each pathological type are mainly solid;（3）In terms of the texture of the tumor section,Soft or tough is the most common in seminoma;tough is the most common in embryonal carcinoma and PTL.5、（1）Seminoma CD117,PLAP,CK-pan,and SALL4 positive rates were all above 90%,while CD30 was negative,and CK-pan was almost negative;（2）embryonal carcinoma CD30,Oct3/4,SALL4 were all positive,more than half of PLAP and CK-pan were positive,and almost all of them were negative for CD117;（3）The positive rate of CD20,CD79α,PAX-5,and Bcl-6 in PTL was 100%,and the partial positive rate of Ki-67 and Myc in PTL was 100%.the partial positive rate of Bcl-2 was above 70%,and the positive rate of Mum-1 was above 90%.6、（1）42 patients received radiotherapy,of which 16 patients had no adverse reactions,accounting for 38.1%;among the adverse reactions,gastrointestinal reactions（15 cases of nausea,3 cases of vomiting,and 3 cases of decreased appetite）and bone marrow suppression（Leukopenia in 13 cases,thrombocytopenia in 1 case）was the most common,and fatigue was occasionally seen.（2）There were 10 patients who received EP chemotherapy,8 patients had neutrophil suppression,the incidence rate was 80%,3 patients had nausea,the incidence rate was 30%,and 1 patient felt fatigue,the incidence rate accounted for 10%,only 1 patient had no adverse reactions;most of the patients who received BEP chemotherapy had no obvious adverse reactions,and only 1 patient had low back pain.（3）A total of 30 patients had a history of cryptorchidism,26 cases of seminoma,accounting for 86.7%;3 cases of mixed germ cell tumor,accounting for 10.0%;1 case of embryonal carcinoma,accounting for 3.3%.Therefore,the most common pathological type of cryptorchid malignancy is seminoma.7、（1）Kaplan-Meier survival analysis and log-rank test showed that there was no significant difference in the prognosis of patients with different disease courses and history of cryptorchidism（P>0.05）.There were significant differences in the prognosis of patients with different age,tumor size,clinical stage,radiotherapy and chemotherapy,and pathological type（P<0.05）;（2）The results of COX multivariate regression analysis showed that age and clinical stage were statistically significant in the model（P<0.05）,that is,age and clinical stage were independent risk factors affecting the survival rate of patients.Conclusion:1.Testicular germ cell tumors are more common in young and middle-aged patients aged 20-40 years,and PTL are more common in elderly men over 50 years old.2.Seminoma usually has normal tumor markers,and non-seminomatous AFP andβ-HCG increase rates are higher than those of seminoma;primary testicular lymphoma often increases LDH.3.Most of the cut surfaces of testicular malignant tumors are light brown,and most of them are solid tumors.4.CD30 can be used as an important basis for distinguishing seminoma and embryonal carcinoma.Seminoma is negative for CD30,and embryonal carcinoma is positive for CD30.4.The most common adverse reactions of radiotherapy are myelosuppression and gastrointestinal reactions,the most common malignant transformation of cryptorchidism is seminoma.5.Age,tumor size,clinical stage,whether to accept radiotherapy and chemotherapy,and pathological type are the factors that affect the survival rate of patients. |
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