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作者报告一例原发脊髓圆锥生殖细胞瘤。患者,男性、24岁,因下腰背部间歇性疼痛伴早期排尿困难4个月,双下肢麻木2个月入院。查体:双侧骶神经分布区感觉减退,膝腱反射亢进,踝反射减弱,膀胱内压测量图显示失张力神经原性膀胱,MR示T_(12)～L_3椎管内均匀高信号区,脊髓影像显示L_3水平占位病变。术前诊断为原发脊髓内肿瘤,手术切除示T_(12)～L_3椎板,沿中线中切开硬膜及蛛网膜,见脊髓圆锥隆起,L_(1-3)水平肿瘤向髓外生长,予以切除,脊髓圆锥肿瘤经中线部分脊髓切除。病理显微镜下检查见边界清楚的巨大细胞,核仁大,可见肿瘤浸润淋巴细胞,未见合胞体滋养层细胞。病理诊断:生殖细胞瘤。胎盘碱性磷酸酶(PLAP)免疫组织化学染色法阳性。术后脑、颈、胸椎MR检查未见肿瘤,泌尿系检查骨盆,胸腹部CT及甲胎蛋白(AFP)、癌胚抗原(CEA)、人绒毛膜促性腺激素(HCG)、PLAP等血液检查均正常。术后2周复查MR,肿瘤部位SGy放疗后明显缩小,最后行示T_(12)～L_340Gy放疗及15Gy全脊髓放疗,术后15个月未见肿瘤复发。
The authors report a case of primary spinal condyloma. Patient, male, 24 years old, with intermittent pain in lower back and back with early dysuria for 4 months and numbness in both lower extremities for 2 months. Examination: Bilateral sacral nerve distribution decreased sensation, knee tendon reflexes, ankle reflex, bladder pressure measurement showed that the nervous system of nervous tension, MR showed T_ (12) ~ L_3 uniform high signal area within the spinal canal, Spinal images showed L_3 level lesions. Preoperative diagnosis of primary spinal cord tumors, surgical removal of T_ (12) ~ L_3 lamina, along the midline incision dural and arachnoid, see the spinal conical bulge, L_ (1-3) level of extramedullary tumor growth , To be removed, spinal cord conus tumor by midline partial spinal cord resection. Check the pathological microscope, see the clear boundary of the giant cells, large nucleoli, visible tumor infiltrating lymphocytes, no syncytiotrophoblast cells. Pathological diagnosis: germ cell tumor. Placental alkaline phosphatase (PLAP) immunohistochemical staining was positive. Postoperative brain, neck, thoracic MR examination showed no tumor, urinary pelvic examination, chest and abdomen CT and AFP, carcinoembryonic antigen (CEA), human chorionic gonadotropin (HCG), PLAP and other blood tests All normal. After 2 weeks’ reexamination of MR, the tumor site of SGy was significantly reduced after radiotherapy, and finally showed T_ (12) ~ L_340Gy radiotherapy and 15Gy whole spinal cord radiotherapy. There was no tumor recurrence 15 months after operation.