Pellegrino Micaela, Gianotti Laura, Cassibba Sara, Brizio Rodolfo, Terzi Alberto, Borretta Giorgio
Division of Endocrinology and Metabolism, Department of Internal Medicine, S. Croce e Carle Hospital, Via M. Coppino 26, 12100 Cuneo, Italy.
Case Rep Med. 2012;2012:952645. doi: 10.1155/2012/952645. Epub 2012 Aug 23.
Objective. To report the rare case of a thymic neuroblastoma, in an elderly woman with SIADH at presentation. Methods. Clinical and biochemical data of the patient are presented and the pertinent literature is reviewed. Results. a 79-year-old woman was admitted into our department with worsening asthenia, severe hyponatremia (114.8 mEq/L), low plasma osmolarity (253 mEq/L), and inappropriate urinary sodium concentration (151 mEq/L). CT scan showed an a large solid inhomogeneous mass in the anterior mediastinum. (18)F-FDG-PET/CT showed uptake in the mass. On continuous 3% hypertonic saline infusion, sodium gradually increased without achieving normal values. The patient underwent surgery, followed by full normalization of sodium levels. Tumor cells were positive for neuroendocrine markers. Thymic neuroblastoma with SIADH was diagnosed. Conclusions. Neuroblastoma is an extremely rare tumor in the elderly. Contrary to children and younger adults, neuroblastoma in older adults is typically localized in the anterior mediastinum and is often associated with SIADH. Moreover, it has mainly local aggressiveness in this age group, without metastatic spread; thus radical surgery achieves cure in most cases.
目的。报告1例罕见的胸腺神经母细胞瘤病例，该病例为一名老年女性，就诊时伴有抗利尿激素分泌异常综合征（SIADH）。方法。介绍该患者的临床和生化数据，并复习相关文献。结果。一名79岁女性因乏力加重、严重低钠血症（114.8 mEq/L）、低血浆渗透压（253 mEq/L）和不适当的尿钠浓度（151 mEq/L）入住我科。CT扫描显示前纵隔有一个大的实性不均匀肿块。（18）F-FDG-PET/CT显示肿块有摄取。持续输注3%高渗盐水后，钠逐渐升高但未达到正常水平。患者接受了手术，随后钠水平完全恢复正常。肿瘤细胞神经内分泌标志物呈阳性。诊断为伴有SIADH的胸腺神经母细胞瘤。结论。神经母细胞瘤在老年人中极为罕见。与儿童和年轻成年人不同，老年人的神经母细胞瘤通常位于前纵隔，且常与SIADH相关。此外，在这个年龄组中它主要具有局部侵袭性，无转移扩散；因此，根治性手术在大多数情况下可实现治愈。
