Case Analysis And Literature Review Of Pulmonary Metastatic Adult Testis Granulosa Cell Tumor

Background:granulosa cell tumours is a kind of tumor in the direction of the granulosa cells of ovarian follicle differentiated sex cord stromal tumor,is often diagnosed in middle-aged or postmenopausal women.WHO Classification of Tumours of the Urinary System and Male Genital Organs?2016?pointed out that occur in the type of Adult testis GCTs account for less than 0.5%^[1],all the sex cord stromal tumors with transfer cases more rare,only 9 cases reported at home and abroad.Due to the Adult type testicular granulosa cell tumor instance limited experience,according to the clinical pathological features,it is difficult to predict the tumor biological behavior,and the WHO?2016?Classification of Tumours of the Urinary System and Male Genital Organs will remain its designated for malignant potential not qualitative lesions?ICDO code:8620/1?^[1].So,how to define the biological behavior of ATGCTs and prompt and guide clinicians to carry out effective treatment and prognostic follow-up according to the pathological characteristics in clinical pathological work is extremely important.Objective:We report a case of ATGCTS with pulmonary metastasis within 9 months and died three months later.By reviewing related literature,learning ATGCTs patients relevant epidemiological history,clinical pathological histology,operation method and the prognosis,etc.To improve our understanding of the biological behavior and prognosis of ATGCTs level.Methods:1?The tissue samples were treated strictly according to the operation standard of pathology department.2?ATGCTs in this case were described in combination with clinical and pathological case report specifications.3?All cases of ATGCTs published in domestic and foreign databases?pubmed,CNKI,Wanfang,Weipu,etc.?were searched.4?The inclusion criteria are those cases that meet the pathological diagnostic criteria of ATGCTs,excluding those that cannot read the full text and repeated reports.5?Study and analyze relevant literature,extract the datas of epidemiological history,clinical manifestation,histopathological manifestation,surgical plan and prognosis follow-up of patients,and conduct statistical treatment when necessary.Results:All case reports on ATGCTs published in domestic and foreign databases?pubmed,CNKI,wanfang,weipu,etc.?were searched,and a total of 73 cases were retrieved?the first case was not available in full text in 1952?.Summarize its characteristics:?1?Age of onset:12-87 years,with an average age of 44 years,The median age was 44;?2?Location of onset:located within the testicular parenchyma?40 left,34 right?;?3?Clinical manifestations:progressively enlarged painless mass,A few patients had male breast development,and a few had history of cryptorchidism.Laboratory examination:serology AFP,?-HCG,LDH et al.Ultrasound examination often presents hypoechoic lesions with clear tumor boundaries and internal blood flow signals;?4?Clinicopathological features:the maximum diameter of tumors ranged from 0.46 cm to 13 cm,with an average diameter of about 3.9 cm;grey-white,grey-yellow and grey-brown colors were visible,mainly grey-yellow;solid patchy,trabecular,island-shaped,large follicles and small follicles were visible under the microscope,with round to oval nuclei and sparse cytoplasm,Longitudinal groove and chrysanthemum like structure?call Exner body?can be seen;Immunophenotype:The tumor cells were positive for inhibin,vimentin and calretinin,positive for CD99and WT-1,and negative for cytokeratin,EMA,PLAP,Syn and LCA.?5?Adult GCT occurring in testis should be differentiated from juvenile GCT,seminoma,yolk sac tumor and lymphoma.?6?At present,the main treatment is radical orchiectomy alone.?7?Follow-up time:ranging from 0 to 169 months.Conclusion:1?We believe that indicators of the biological behavior of ATGCTs with metastasis may include:primary tumor diameter greater than 4cm and vascular lymphatic invasion.Due to the limited number of cases and the incomplete information of some cases,the ability of necrosis and invasive boundaries to predict the biological behavior of ATGCTs remains to be further verified.2?Retroperitoneal lymph node dissection?RPLND?may have some application value in some tumors with malignant biological behavior or small volume.3?Long-term follow-up is necessary for patients with ATGCTs.