Department of Oncology, 309th Hospital of PLA, Beijing, 100091, China.
Med Oncol. 2012 Dec;29(4):2649-53. doi: 10.1007/s12032-012-0200-5. Epub 2012 Mar 6.
A 28-year-old man complained of intermittent irritable dry cough for 2 months with occasional bloody sputum. Positron emission tomography-computed tomography (PET-CT) suggested multiple heterogeneous soft tissue masses in the inferior lobes of both lungs, with heterogeneous increases in 18F-FDG uptake. No metabolic disorders were found in the rest of the body. CT-guided percutaneous lung puncture and biopsy and immunohistochemical study confirmed pulmonary primitive neuroectodermal tumor (PNET). PNET is characterized by small round blue cells and positive CD99 expression. After six cycles of chemotherapy with ifosfamide, dacarbazine and cisplatin, the lesions diminished substantially. At 2 months after the last cycle of chemotherapy, the patient complained of exertional dyspnea. PET-CT and echocardiogram suggested a space-occupying lesion in the right atrium. Autopsy revealed that this space-occupying lesion had the same pathomorphology and immunophenotype with pulmonary PNET, suggesting metastasis of pulmonary PNET to the right atrium. Here, we reported this rare case of pulmonary PNET metastasizing, instead of direct infiltrating or extending, into the heart.
一名 28 岁男性，间断性干咳 2 个月，伴偶发血痰。正电子发射断层扫描-计算机断层扫描（PET-CT）提示双肺下叶多个异质性软组织肿块，18F-FDG 摄取不均匀增加。全身其他部位未见代谢异常。CT 引导经皮肺穿刺活检和免疫组化研究证实为肺原始神经外胚层肿瘤（PNET）。PNET 的特征是小圆蓝细胞，CD99 表达阳性。伊立替康、达卡巴嗪和顺铂化疗 6 个周期后，病灶明显缩小。化疗最后一个周期后 2 个月，患者出现活动后呼吸困难。PET-CT 和超声心动图提示右心房占位性病变。尸检显示该占位性病变与肺部 PNET 具有相同的形态学和免疫表型，提示肺部 PNET 转移至右心房。本病例报道了一种罕见的肺 PNET 转移而不是直接浸润或延伸至心脏的情况。
