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Serum free-beta human chorionic gonadotropin (fbhCG) has been used for the diagnosis and management of testicular tumors for many years in Japan, while the measurement of serum hCG is widely used in the world. There have been reports of false-positive cases with serum fbhCG and due care must be taken in order not to take the wrong treatment strategy. Serum hCG is said to be more useful in the diagnosis and management of non-seminoma than serum fbhGC. Because of the false-positive issue with serum fbhCG, however, we consider it appropriate to use serum hCG for measurement even in seminoma. We simultaneously measured serum hCG and serum fbhCG in 25 cases of seminoma in order to evaluate the usefulness of hCG assay in the diagnosis and management of seminoma. In the measurements, we found 5 false-positive cases (20%) with serum fbhCG. The diagnostic sensitivity of the 20 cases with the exception of the 5 false-positive cases was 16 cases (80%) and 14 cases (70%) with serum hCG and serum fbhCG, respectively. We conclude that serum hCG is more reliable and is a useful assay in the diagnosis and management of seminoma, but serum fbhCG is not useful in the diagnosis and management of testicular tumor and its independent measurement should not be used to avoid misleading results.

A 79-year-old man, complaining of right hypochondralgia, was admitted to our hospital. Gastrointestinalendoscopy revealed a elevated lesion on the anterior wall of the gastric antrum. Adistal gastrectomy was performed. Histological findings confirmed the diagnosis of gastric choriocarcinoma,and there was coexistence of adenocarcinoma. The patient left the hospital in uneventfulpostoperative course. He had recurrence on remnant stomach on the third postoperativemonth. Also chemotherapy with TS-1 and paclitaxel was performed, was no effective, resulting inpatient death on the fourth postoperative month. The patient died of recurrence complicatedpneumonia. We reported on this case with some bibliographical comments.

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成人睾丸精細胞性腫瘍患者110例中19例にhCG陽性例を認め, 臨床的検討をおこなった.1)セミノーマ65例中2例, 非セミノーマ45例中17例がhCG陽性であった.2) hCG陽性19例のうち絨毛癌を確認できたものは10例, 確認できなかったものは9例であった.3) hCG陽性例において原発巣と転移巣の組織型を比較したところ, 不一致例が多く睾丸腫瘍の組織診断のむつかしさを示した.4)血中hCG濃度と絨毛癌の有無については, 絨毛癌の証明されたものでは3, 000 mIU/ml以上と高値を示し, 絨毛癌の証明されなかったものは1, 000 mIU/ml以下と低値であった.5) hCG陽性例は絨毛癌組織の有無にかかわらず陰性例に比べ進行例が多いために予後が悪かった.6) hCG陽性例でも予後はstageに関係し, stage 1の予後はよく2, 3で悪い傾向がうかがえた, The outcome of clinical therapy of testis tumor presenting with positive human chorionic gonadotropin (hCG) in our hospital is reported. Of 110 patients with adult germ cell testis tumor, 19 (17.3%) had elevated hCG levels in serum or urine. Two (3.1%) of the 65 patients with seminoma and 17 (37.8%) of the 45 non-seminoma patients had positive hCG. Chorionic elements were confirmed at primary and/or metastatic sites in 10 (52.6%) of these patients, and in not a few cases different histologic features were seen at the two sites. Many patients with chorionic elements had high hCG levels (more than 3, 000 mIU/ml) in serum, while patients in whom no chorionic elements were detected had low hCG levels (below 1, 000 mIU/ml). The hCG-positive group seemed to have a poor prognosis because they were mostly in an advanced stage at their first visit to the hospital, and no difference in prognosis was found between the patients with chorionic elements and those without. The advanced group had a poor prognosis irrespective of their hCG levels.

1)セミノーマ38例について間接immunoperoxidase法を用いてHCG様物質の局在を検索したところ5例(13%)にこれを認めた.2) HCG様物質の局在はいわゆるSTGCのほかに単核のセミノーマ細胞に類似の腫瘍細胞にも認められた.3) HCG値があきらかに陽性であるにもかかわらず, HCG陽性細胞が認められなかった症例が5例あったが, 検索した切片の数の不足が原因と考えられた.bulky stage 2の1例は癌死したが4例は健在である.4)セミノーマにおけるSTGCの存在あるいは軽度の血中あるいは尿中HCG値の上昇は, low stageであれば従来の放射線治療であれ, 化学療法であれ予後は良好と思われた, In a retrospective study of 38 patients with pure seminoma, serum and urine levels of human chorionic gonadotropin (HCG) were measured and the cellular origin of HCG-like substance was searched using the technique of indirect immunoperoxidase on step sections of the tumors. Eight of the patients had elevated HCG in serum or urine, and 5 had HCG-positive cells in the sections of tumor specimens. With this technique, two types of HCG-positive cells were identified, syncytiotrophoblastic giant cells (STGC) and mononuclear cells otherwise indistinguishable from seminoma cells. Patients in the present series responded well to conventional radiation therapy or cytotoxic chemotherapy and had a favorable outcome regardless of the presence of STGC or slightly elevated HCG levels.

It has been a major enigma that a fetus would not be rejected by a immune competent mother, although a fetus is an immunological alien for a mother. And it is a natural phenomenon that various types of immunological changes are generated in a pregnant woman. In this study, for the purpose of examining the changes of cellular immunity in a pregnant women, following analyses were performed. The proportion of sheep erythrocyte-rosette forming cells (E-FRC) and erythrocyte-antibody-complement rosette forming cells (EAC-RFC) was analysed in peripheral blood of non pregnant women and various types of pregnant women. The subpopulations of peripheral blood lymphocytes (PBL) were also analysed by means of flowcytemetry, And, moreover, the change of proportion of rosette forming cells of PBL was examined by in vitro preincubation with human chorionic gonadotropin (hCG). The outline of results obtained was as follows: 1. The propottion of E-RFC of PBL was significantly low in normal early pregnant women and patients with total hydatidiform mole compared with that in normal nonpregnant women. Conversely, the proportion of EAC-RFC was significantly high in normal early pregnant women and patients with total hydatidiform mole compared with that in normal nonpregnant women. 2. The longitudinal study of the proportion of E-RFC and EAC-RFC throughout pregnant state showed that the proportion of E-RFC decreased at 1st trimester and recovered in normal range at 2nd and 3rd trimester, and the proportion EAC-RFC increased at 1st trimester and also recovered in normal range at 2nd and 3rd trimester. 3. The proportion of CD3-, CD4-, CD8- and CD 19-positive cells of PBL was not significantly different among normal nonpregnant women, normal pregnant women in 1st trimester and patients with spontaneous aborion. 4. The proportion of E-RFC of PBL was observed to decrease by in vitro preincubation with hCG, and the proportion of EAC-RFC was observed to increase by means of the same treatment. These data indicate that in early pregnant state rosette-receptor positive cells in PBL showed significant alteration as compared with those in nonpregnant state, and this alteration are considered to be induced by the existance of hCG. The importance of such changes of cellular immunity in pregnant women has not yet fully resolved. For several years, however, the importance of suppressor cells in decidual tissues concerning immunologically successful continuation of pregnancy has been reported. And in near future, the implication of such alteration, i. e. , the change of E-RFC and EAC-RFC of PBL, and the suppressor cells in decidua might be elucidated.

A case of retroperitoneal germ cell tumors in a 32-year-old male is reported. He was admitted to our hospital with complaints of lumbago and abdominal mass. He was diagnosed with primary retroperitoneal malignant tumor and underwent resection of the tumor with retroperitoneal lymphadenectomy. The final pathological diagnosis revealed germ cell tumors of more than one histological type in the retroperitoneal space. Serum human chorionic gonadotropin (hCG) and hCG-beta levels were very high preoperatively (4, 8000 mIU/ml, 57 ng/ml, respectively) and they decreased to normal after vinblastine-bleomycin cisplatin combination chemotherapy three times postoperatively. The patient later developed a solitary lung metastasis and died in another hospital 7 months after the operation. Retroperitoneal germ cell tumors in adults are rare. One question continually arises: are they extragonadal occurrences or germ cell tumors or do they represent metastatic lesions from occult testicular tumors?