Natsuhara A, Iwasaki Y, Minagawa T, Takemura Y, Nakanisi M, Nagata K, Harada H, Kubota Y, Yokomura I, Nakagawa M
Second Department of Medicine, Kyoto Prefectural University of Medicine, Kawaramachi, Hirokoji, Kamigyouku, Kyoto, 602-8566 Japan.
Nihon Kokyuki Gakkai Zasshi. 2001 Sep;39(9):705-9.
A 50-year-old male patient with no symptoms was admitted to our hospital for further evaluation of a right superior mediastinal mass shadow found in chest radiographs during a health examination. Computed tomographic (CT) scans demonstrated a middle mediastinal mass of 4 cm in diameter surrounded by the SVC, the ascending aorta and the trachea at the subaortic level. Routine examination disclosed no metastatic or primary lesion elsewhere. A surgical biopsy resulted in a diagnosis of neuroendocrine carcinoma of unknown primary organ. The patient was given 1 course of chemotherapy with CAV-PE, but little effect was seen. However, when a PE regimen combined with thoracic radiation was used, the tumor shrank to half of its size. After the patient subsequently received high-dose treatment with Etoposide, CT imaging and cytologic analysis revealed multiple metastases to the subcutaneous tissue, both adrenal glands and the liver. Lung lesions also spread aggressively, and the patient died of metastasis. Although neuroendocrine carcinomas can arise from the systemic neuroendocrine cells including those in the mediastinum, their appearance in the middle mediastinum is rarely reported.
一名50岁无症状男性患者因健康体检时胸部X线片发现右上纵隔肿块影而入院进一步评估。计算机断层扫描（CT）显示中纵隔有一个直径4厘米的肿块，在主动脉弓下水平被上腔静脉、升主动脉和气管环绕。常规检查未发现其他部位有转移或原发性病变。手术活检诊断为原发器官不明的神经内分泌癌。患者接受了1个疗程的CAV-PE化疗，但效果甚微。然而，当使用PE方案联合胸部放疗时，肿瘤缩小至原来大小的一半。患者随后接受大剂量依托泊苷治疗后，CT成像和细胞学分析显示皮下组织、双侧肾上腺和肝脏均有多处转移。肺部病变也迅速扩散，患者最终死于转移。尽管神经内分泌癌可起源于包括纵隔在内的全身神经内分泌细胞，但中纵隔出现此类肿瘤的报道很少。
