巨大纵隔混合生殖细胞瘤一罕见病例报告及文献复习
生殖细胞肿瘤相对罕见，胚胎学上来源于生殖细胞，通常发生在生殖腺。纵隔生殖细胞瘤约占所有生殖细胞瘤的1- 3%，通常见于前纵隔，转移病灶多见于后纵隔。最具侵袭性的生殖细胞肿瘤亚型是绒毛膜癌、胚胎癌和卵黄囊肿瘤。而精原细胞瘤很少会远距离传播。表现不一，从常规x线摄影的意外发现到危及生命的呼吸和心血管疾病，也可以表现为巨大的胸内生殖细胞肿瘤，就像我们的病例一样。病例报告:30岁男性，既往无慢性疾病，因呼吸困难、咳嗽、食欲减退、体重减轻4个月以上，无胸痛、咯血史，由结核医院中心转诊。胸片显示右侧胸膜完全闭塞，疑似胸腔积液，诊断为胸膜结核和脓胸，开始服用抗结核药物和抗生素，并行胸腔引流，有少量血液。患者病情未好转，转至我院，胸部计算机造影术显示胸部右侧有一个很大的肿块，压迫气管和纵隔至左侧，两侧有少量积液。胸膜超声检查显示肿块和积液，但无脓胸。鉴别诊断为纵隔肿块、腺癌、胸腺癌、淋巴瘤、纤维瘤或纤维肉瘤。 US guided transthoracic fine needle biopsy from the right side mass revealed mixed germ cell tumor. The patient’s condition had rapidly deteriorated prior the confirming the diagnosis or starting with treatments and died because of difficult airway breathing due to deviated and compressed airway and possible pneumothorax after transthoracic biopsy. Conclusion: Germ cell tumors are aggressive and rapidly growing cancers, the previous literature reported the nature of the extragonadal mediastinal germ cell tumor can appear as Giant mass occlude whole lung, compressing the great vessels, adherent to chest wall, pericardium, and lung, like our case and this make a worse prognosis, The estimated event-free survival at 10 years after combined treatment is 80.4%. Chemotherapy, debulking and pneumoctomy are the treatment for such cases.
| AbdulrahmanHakami |
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