Tanaka Yoko, Tago Kentaro, Narabayashi Tomoko, Sasaki Yoshiaki, Iwahashi Eriko, Hibino Chihiro, Iwasaki Teruo, Watanabe Takahiro, Kasugai Tsutomu, Kohama Joji, Ohno Kiyoshi
Dept. of Internal Medicine,Osaka Koseinenkin Hospital.
Gan To Kagaku Ryoho. 2014 May;41(5):627-31.
A 26-year-old man was admitted to our hospital with dyspnea, fever, and weight loss. A chest X-ray showed multiple tumor shadows, and a computed tomography (CT) scan showed swelling of the mediastinal and hilar lymph nodes, a mass in the retroperitoneum, and an embolus in the inferior vena cava. A biopsy from the left cervical lymph node revealeda poorly differentiated adenocarcinoma. Metastatic lung cancer was suspected, but in spite of the examinations, its primary site was unknown. Serum alfa-fetoprotein(AFP)was slightly elevated, but an AFP stain of the tumor was negative. The patient's respiratory failure rapidly worsened, and therefore, additional examinations could not be performed. The patient received chemotherapy with carboplatin and paclitaxel. His condition improved, but the tumor increased in size after 5 courses of chemotherapy. He received chemotherapy with docetaxel as second-line treatment, but it was not effective. The third-line chemotherapy regimen with carboplatin and gemcitabine was effective. In total, he received 7 lines of chemotherapy, and he lived for approximately 12 months since receiving the first chemotherapy regimen. After he died, we were able to perform OCT-4 immunohistochemistry on a tumor biopsy specimen from the lymph node, which came back positive for OCT-4. Therefore, we made a final diagnosis of extragonadal germ cell cancer syndrome.
一名26岁男性因呼吸困难、发热和体重减轻入院。胸部X线显示多个肿瘤阴影，计算机断层扫描（CT）显示纵隔和肺门淋巴结肿大、腹膜后肿块以及下腔静脉栓子。左颈淋巴结活检显示为低分化腺癌。怀疑为转移性肺癌，但尽管进行了各项检查，其原发部位仍不明。血清甲胎蛋白（AFP）略有升高，但肿瘤的AFP染色为阴性。患者呼吸衰竭迅速恶化，因此无法进行进一步检查。患者接受了卡铂和紫杉醇化疗。其病情有所改善，但化疗5个疗程后肿瘤增大。他接受多西他赛作为二线治疗，但无效。卡铂和吉西他滨的三线化疗方案有效。他总共接受了7线化疗，自接受首个化疗方案后存活了约12个月。他死后，我们能够对淋巴结的肿瘤活检标本进行OCT-4免疫组化检查，结果OCT-4呈阳性。因此，我们最终诊断为性腺外生殖细胞癌综合征。
