Department of Internal Medicine, School of Medicine of the Federal University of Minas Gerais, Av. Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, MG, 30130 100, Brazil.
Department of Patology and Legal Medicine, School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
Exp Hematol Oncol. 2013 Apr 30;2:13. doi: 10.1186/2162-3619-2-13. eCollection 2013.
Cardiac metastasis of germ cell tumors is extremely rare, particularly in females. We report a case of a 26-year-old previously healthy woman who presented with a 5-month history of abdominal pain, weight loss, fever, generalized lymphadenopathy, and acanthosis nigricans. Biopsy of cervical lymph nodes revealed a poorly differentiated neoplasm. Immunohistochemical staining was positive for alpha-fetoprotein suggesting the diagnosis of a germ cell tumor. During the investigation, the patient developed heart failure and a mass attached to the right ventricle was detected by the echocardiogram. In a few days, she developed multiple organ failure and died. Post-mortem examination revealed a malignant mixed germ cell tumor of the right ovary with extensive hematogenic and lymphatic dissemination, a polypoid mass attached to the right ventricle, emboli in the endocardial and epicardial vessels, and infiltration surrounding the coronary arteries. To the best of our knowledge this is the third report of grossly visible heart metastases from a yolk sac tumor in a female patient. A summary of all published cases of germ cell tumors with cardiac metastasis over the last 20 years is also presented.
生殖细胞肿瘤的心脏转移极为罕见，尤其是在女性中。我们报告了一例 26 岁的既往健康女性，其因腹痛、体重减轻、发热、全身淋巴结病和黑棘皮病就诊，病史 5 个月。颈部淋巴结活检显示分化差的肿瘤。免疫组织化学染色为甲胎蛋白阳性，提示生殖细胞肿瘤的诊断。在检查过程中，该患者出现心力衰竭，并通过超声心动图发现附着在右心室的肿块。几天后，她出现多器官衰竭并死亡。尸检显示右侧卵巢混合性恶性生殖细胞肿瘤，广泛血行和淋巴播散，附着在右心室的息肉状肿块，心内膜和心外膜血管内有栓子，以及冠状动脉周围浸润。据我们所知，这是第三位女性患者的卵黄囊瘤肉眼可见的心脏转移报告。还总结了过去 20 年所有发表的生殖细胞肿瘤伴心脏转移的病例。
