Inui Masato, Nitadori Jun-Ichi, Tajima Shogo, Yoshioka Takahusa, Hiyama Noriko, Watadani Takeyuki, Shinozaki-Ushiku Aya, Nagayama Kazuhiro, Anraku Masaki, Sato Masaaki, Fukayama Masashi, Nakajima Jun
Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
Department of Thoracic Surgery, School of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan.
Surg Case Rep. 2017 Dec;3(1):7. doi: 10.1186/s40792-016-0278-7. Epub 2017 Jan 5.
An asymptomatic 26-year-old man received an annual medical check-up, and chest X-ray showed a protrusion of the aortopulmonary window. Chest computed tomography (CT) revealed an anterior mediastinal tumor and cysts with thin wall and septum enhancement. The preoperative diagnosis was cystic thymoma or malignant lymphoma. We performed total resection of the tumor through a median sternotomy. The pathological findings revealed seminoma, positive for c-kit stain, and multilocular thymic cysts. Cysts were lined by normal squamous epithelium and no seminoma cells were located on their surface. So, cysts were probably secondary changes caused by seminoma cells themselves or inflammatory stimulations. No invasion to adjacent structures was seen. After the surgery, testicular ultrasound imaging and abdominal, pelvic, and cerebral CT showed no apparent tumor or enlarged lymph nodes; however, an abnormal uptake in the right mesenteric lymph node was pointed out by F-fluorodeoxyglucose-positron emission tomography (FDG-PET) scan. The patient received four courses of bleomycin, etoposide, and cisplatin (BEP) as adjuvant chemotherapy. Follow-up PET scan revealed no uptake in the right mesenteric lymph node. To date, no recurrence or metastasis has been identified for 16 months.
一名26岁无症状男性接受年度体检，胸部X线显示主动脉肺动脉窗突出。胸部计算机断层扫描（CT）显示前纵隔肿瘤及薄壁和间隔强化的囊肿。术前诊断为囊性胸腺瘤或恶性淋巴瘤。我们通过正中胸骨切开术对肿瘤进行了全切除。病理结果显示为精原细胞瘤，c-kit染色阳性，以及多房性胸腺囊肿。囊肿内衬正常鳞状上皮，其表面未见精原细胞瘤细胞。因此，囊肿可能是精原细胞瘤细胞自身或炎症刺激引起的继发性改变。未见对相邻结构的侵犯。术后，睾丸超声成像及腹部、盆腔和脑部CT均未显示明显肿瘤或肿大淋巴结；然而，氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）显示右肠系膜淋巴结有异常摄取。患者接受了四个疗程的博来霉素、依托泊苷和顺铂（BEP）辅助化疗。随访PET扫描显示右肠系膜淋巴结无摄取。迄今为止，16个月来未发现复发或转移。
