Sakai S, Tomita R, Tanaka H, Nakahara K, Mimoto H, Kokubo M
Department of Respiratory Diseases, Gifu City Hospital.
Nihon Kyobu Shikkan Gakkai Zasshi. 1992 Jun;30(6):1186-91.
A 38-year-old male was admitted with edema of the neck and face. Chest X-ray revealed a mediastinal tumor. On chest CT and MRI, a tumor infiltrating the superior vena cava and bilateral brachiocephalic veins in the upper mediastinum was observed. Venography revealed obstruction of bilateral brachiocephalic veins. The tumor was diagnosed as thymoma by percutaneous biopsy, but since it was of stage III according to Masaoka's classification, complete extirpation was considered to be impossible. Preoperative chemotherapy with multiple drugs (CDDP, ADM, VCR, CPA) was administered. The superior vena cava syndrome resolved and the tumor diminished in size. Because of leukopenia, rhG-CSF was also used. The tumor infiltrated the left brachiocephalic vein; therefore, total resection and left brachiocephalic vein reconstruction were performed. Histopathological examination showed extensive, necrosis and fibrosis containing residual thymoma. Postoperatively, similar chemotherapy and cobalt irradiation (40 Gy) to the superior mediastinum were performed. We thus present a case of invasive thymoma which responded to preoperative chemotherapy.
一名38岁男性因颈部和面部水肿入院。胸部X线检查发现纵隔肿瘤。胸部CT和MRI显示上纵隔有一个肿瘤浸润上腔静脉和双侧头臂静脉。静脉造影显示双侧头臂静脉阻塞。经皮活检将肿瘤诊断为胸腺瘤，但根据Masaoka分类法其为III期，因此认为无法完全切除。给予多种药物（顺铂、阿霉素、长春新碱、环磷酰胺）进行术前化疗。上腔静脉综合征得到缓解，肿瘤体积缩小。由于白细胞减少，还使用了重组人粒细胞集落刺激因子（rhG-CSF）。肿瘤浸润左头臂静脉；因此，进行了全切除和左头臂静脉重建。组织病理学检查显示广泛坏死和纤维化，伴有残留胸腺瘤。术后，进行了类似的化疗并对上纵隔进行了钴照射（40 Gy）。我们在此呈现一例对术前化疗有反应的侵袭性胸腺瘤病例。
