Tinica G, Butcovan D, Cimpeanu C, Târcoveanu E
Cardiovascular Surgery Department, Gr. T. Popa University of Medicine and Pharmacy, Iaşi.
Chirurgia (Bucur). 2010 Nov-Dec;105(6):831-4.
We report an extremely rare case of germ-cell tumor localized at the level of the anterior mediastinum.
A 36-year-old man who presented with left subclavial vein thrombosis was admitted to our hospital for specific cure. Computed tomographic scan of the chest showed a large anterior mediastinal mass. Surgical intervention revealed an infiltrative mediastinal tumor involving the left subclavial vein, which was biopsied for morphological examination. Histologically, the tumoral mass proved to be a carcinoma, with papillary and tubular growth patterns. Immunohistochemical stains for alpha-fetoprotein were positive in the tumor cells while stains for carcinoembryonic antigen and placental like alkaline phosphatase were negative. The serum level of alpha-fetoprotein of this patient was elevated, as well. This supported the diagnosis of Yolk sac tumor, a rare primary tumor within the mediastinum. Postsurgery, the patient received a combination chemotherapy consisting of cisplatin, vepesid and bleomycin every 3 weeks for a total of 4 cycles. During the treatment, the alpha-fetoprotein level, was decreasing.
Primary mediastinal Yolk sac neoplasm is a rare tumor. The diagnosis should be made not only by morphological studies but also the patient's age and the elevation of serum alpha-fetoprotein. In spite of modern chemotherapy, the prognosis of mediastinal yolk sac tumor remains poor. The single most important prognostic indicator is whether the tumor mass can be completely excised before or after chemotherapy.
我们报告一例极为罕见的位于前纵隔水平的生殖细胞肿瘤病例。
一名36岁男性因左锁骨下静脉血栓形成前来我院寻求特效治疗。胸部计算机断层扫描显示前纵隔有一个巨大肿块。手术干预发现一个浸润性纵隔肿瘤累及左锁骨下静脉，对其进行活检以进行形态学检查。组织学检查显示肿瘤块为癌，具有乳头状和管状生长模式。肿瘤细胞中α-甲胎蛋白免疫组化染色呈阳性，而癌胚抗原和胎盘样碱性磷酸酶染色呈阴性。该患者的血清α-甲胎蛋白水平也升高。这支持了卵黄囊瘤的诊断，这是一种罕见的纵隔原发性肿瘤。术后，患者每3周接受一次由顺铂、依托泊苷和博来霉素组成的联合化疗，共4个周期。在治疗期间，α-甲胎蛋白水平逐渐下降。
原发性纵隔卵黄囊肿瘤是一种罕见肿瘤。诊断不仅应通过形态学研究，还应结合患者年龄和血清α-甲胎蛋白升高情况。尽管有现代化疗方法，纵隔卵黄囊肿瘤的预后仍然很差。最重要的预后指标是肿瘤块在化疗前或化疗后能否完全切除。
