原发性纵隔恶性生殖细胞瘤2例并文献复习

Primary malignant mediastinal germ cell tumor: report of two cases and literature review

目的提高对原发性纵隔恶性生殖细胞瘤(primary malignant mediastinal germ cell tumor,PMMGCT)的认识。方法回顾分析2例PMMGCT患者的临床资料,并检索复习文献。结果病例1,男性,22岁,咳嗽、呼吸困难5个月,胸部CT显示前纵隔巨大肿物,血β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-HCG)升高,超声引导穿刺病理为精原细胞瘤。病例2,男性,20岁,胸痛10 d,胸部CT显示前纵隔巨大肿物,血甲胎蛋白(α-fetoprotein,AFP)明显升高,CT引导穿刺病理为纵隔卵黄囊瘤。回顾文献,PMMGCT多见于青年男性,症状缺乏特异性,胸部CT可见巨大肿物多位于前纵隔,内部可见低密度囊性改变和钙化。精原细胞瘤血β-HCG升高,卵黄囊瘤血AFP明显升高。PMMGCT对化学药物治疗(以下简称化疗)敏感,首选含铂类的联合化疗,后可辅以手术或放射治疗清除残留病灶。结论 PMMGCT临床罕见,呼吸科和放射科医师应提高认识,为患者争取较好的预后。

Objective To improve the recognition of primary malignant mediastinal germ cell tumor（ PMMGCT）. Methods We describe in detail the clinical data of 2 patients with PMMGCT,and reviewed the relevant literature. Results Patient 1,a 22-year-old man,presented with cough and dyspnea for 5 months. Chest CT showed a large homogeneous mass. Serum beta human chorionic gonadotrop（ h） in（ β-HCG） level was elevated. Ultrasound-guided biopsy confirmed seminoma. Patient 2,a 20 year-old man,presented with chest pain for 10 days. Chest CT showed a large heterogeneous mass,and his serum alpha-fetoprotein（ AFP） level elevated significantly. CT-guided biopsy confirmed yolk sac tumor. PMMGCT is seen almost exclusively in young men. Symptoms usually are nonspecific. Chest CT often shows a large heterogeneous mass with obliteration of adjacent fat planes. Elevated serum AFP or β-HCG can be used as diagnostic clues. PMMGCT are highly sensitive to cisplatin-based chemotherapy,followed by radiotherapy or surgical resection. Conclusion PMMGCT patients are rarely seen clinically. Respiratory and radiological physicians should raise awareness and strive for a better prognosis.