Francischetti Ivo M B, Cajigas Antonio, Suhrland Mark, Farinhas Joaquim M, Khader Samer
Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
Division of Cytology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
Diagn Cytopathol. 2017 Aug;45(8):738-743. doi: 10.1002/dc.23719. Epub 2017 Apr 11.
We describe a case of a 41-year old male patient with no significant prior medical history who presents with symptoms of Transient Ischemic Attack and stroke. Magnetic Resonance Imaging (MRI) of the brain identified areas of ischemia in the left side, and angiography showed occlusion of the left Medial Cerebral Artery (MCA). Cardiac Transthoracic Echocardiogram (TTE) for stroke evaluation incidentally noted a mediastinal abnormality leading to cancer work-up. Computer Tomography (CT) and F-fluorodeoxyglucose (FDG) PET-CT scan of the chest incidentally revealed an avid 6 cm paraesophagial/subcarinal mass. Further diagnostic work-up with endoscopic and endobronchial ultra sound (EBUS)-guided fine needle aspiration (FNA) of the mass yielded a cytology diagnosis of Germ Cell Tumor (GCT), with choriocarcinoma component. Additionally, high plasma levels of β-human chorionic gonadotrophin (β-HCG) were detected with no evidence of testicular tumor. This exceedingly rare presentation for a primary mediastinal choriocarcinoma underscores the importance of complete investigation of young patients presenting with neurological symptoms compatible with ischemic events. Diagn. Cytopathol. 2017;45:738-743. © 2017 Wiley Periodicals, Inc.
我们描述了一例41岁男性患者，其既往无重大病史，出现短暂性脑缺血发作和中风症状。脑部磁共振成像（MRI）发现左侧有缺血区域，血管造影显示左大脑中动脉（MCA）闭塞。用于中风评估的心脏经胸超声心动图（TTE）偶然发现纵隔异常，进而进行癌症检查。胸部计算机断层扫描（CT）和F-氟脱氧葡萄糖（FDG）PET-CT扫描偶然发现一个6 cm的食管旁/隆突下高代谢肿块。对该肿块进行进一步诊断检查，通过内镜和支气管内超声（EBUS）引导下细针穿刺活检（FNA），获得了生殖细胞肿瘤（GCT）伴绒毛膜癌成分的细胞学诊断。此外，检测到血浆β-人绒毛膜促性腺激素（β-HCG）水平升高，且未发现睾丸肿瘤证据。这种原发性纵隔绒毛膜癌极为罕见的表现突出了对出现与缺血事件相符的神经症状的年轻患者进行全面检查的重要性。诊断细胞病理学。2017年；45:738 - 743。©2017威利期刊公司
