原发性纵隔恶性生殖细胞瘤2例并文献复习

doi:10.3969/j.issn.1006-7795.2016.05.003

首都医科大学学报 ›› 2016, Vol. 37 ›› Issue (5): 574-578.doi: 10.3969/j.issn.1006-7795.2016.05.003

原发性纵隔恶性生殖细胞瘤2例并文献复习

路明¹, 陈红姗^1,2, 韩翔¹, 杨薇¹, 朱翔³, 朱红¹, 贺蓓¹, 姚婉贞¹

1. 北京大学第三医院呼吸科, 北京 100191;
2. 北京市延庆县医院肿瘤科, 北京 102100;
3. 北京大学第三医院病理科, 北京 100191

收稿日期:2016-06-30 出版日期:2016-10-21 发布日期:2016-10-19
通讯作者: 姚婉贞 E-mail:yaowanzhen@126.com
基金资助:
中华医学会临床医学科研专项基金（QT09-5-09）。

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

Lu Ming¹, Chen Hongshan^1,2, Han Xiang¹, Yang Wei¹, Zhu Xiang³, Zhu Hong¹, He Bei¹, Yao Wanzhen¹

1. Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China;
2. Department of Oncology, Beijing Yanqing County Hospital, Beijing 102100, China;
3. Department of Pathology, Peking University Third Hospital, Beijing 100191, China

Received:2016-06-30 Online:2016-10-21 Published:2016-10-19
Supported by:
This study was supported by Chinese Medical Association of Clinical Medicine Research Fund(QT09-5-09).

摘要/Abstract

摘要： 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。

关键词: 前纵隔肿物, 原发性纵隔恶性生殖细胞肿瘤, 诊断, 治疗

Abstract: 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.

Key words: anterior mediastinal masses, primary malignant mediastinal germ cell tumors, diagnose, treatment

中图分类号:

R734.5

路明, 陈红姗, 韩翔, 杨薇, 朱翔, 朱红, 贺蓓, 姚婉贞. 原发性纵隔恶性生殖细胞瘤2例并文献复习[J]. 首都医科大学学报, 2016, 37(5): 574-578.

Lu Ming, Chen Hongshan, Han Xiang, Yang Wei, Zhu Xiang, Zhu Hong, He Bei, Yao Wanzhen. Primary malignant mediastinal germ cell tumor: report of two cases and literature review[J]. Journal of Capital Medical University, 2016, 37(5): 574-578.

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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

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