Department of Thoracic Surgery, Peking University First Hospital, Peking University, Peking, China.
Thorac Cancer. 2018 Apr;9(4):491-494. doi: 10.1111/1759-7714.12591. Epub 2018 Jan 10.
Primary mediastinal yolk sac tumor, which is also known as endodermal sinus tumor, is a rare but lethal neoplasm, and it is a kind of mediastinal non-seminomatous germ cell tumor. The current standard treatment in mediastinal non-seminomatous germ cell tumors is chemotherapy combined with postchemotherapy residual mass resection. We report on seven cases of primary mediastinal yolk sac tumor treated with platinum-based chemotherapy and extended resection.
We experienced seven cases of primary mediastinal yolk sac tumor between August 2014 and August 2017. All cases had markedly raised α-fetoprotein and normal β-human chorion gonadotropin. Computed tomography scan revealed an anterior mediastinal tumor in all cases. Five patients underwent needle core biopsy, which showed a mediastinal yolk sac tumor. They received preoperative platinum-based chemotherapy and then underwent extended resection, and four of them received postoperative platinum-based chemotherapy. Two other patients did not receive preoperative biopsy, and they underwent surgical extended resection and then received postoperative platinum-based chemotherapy.
Two patients (29%) experienced a postoperative complication, including one pneumonia and one atelectasis. There were no operative deaths. R0 resection was achieved in six patients (86%), and R2 resection was achieved in the other patient. Three patients experienced pulmonary metastases within one year, and two of them soon died. Four other patients were alive without recurrence at the time of writing.
Primary mediastinal yolk sac tumor is rare, and the prognosis is poor. A multimodality aggressive approach including adjuvant chemotherapy followed by surgical resection is the optimal treatment and may lead to long-term survival.
原发性纵隔卵黄囊瘤，又称内胚窦瘤，是一种罕见但致命的肿瘤，属于纵隔非精原细胞瘤生殖细胞肿瘤。目前，纵隔非精原细胞瘤生殖细胞肿瘤的标准治疗方法是化疗联合化疗后残余肿块切除术。我们报告了 7 例接受铂类化疗和扩大切除术治疗的原发性纵隔卵黄囊瘤病例。
我们在 2014 年 8 月至 2017 年 8 月期间共治疗了 7 例原发性纵隔卵黄囊瘤患者。所有患者的α-胎蛋白明显升高，β-人绒毛膜促性腺激素正常。计算机断层扫描显示所有病例均有前纵隔肿瘤。5 例患者接受了针芯活检，均显示为纵隔卵黄囊瘤。他们接受了术前铂类化疗，然后进行了扩大切除术，其中 4 例接受了术后铂类化疗。另外 2 例患者未接受术前活检，接受了扩大手术切除术和术后铂类化疗。
2 例患者（29%）发生术后并发症，包括肺炎 1 例，肺不张 1 例。无手术死亡。6 例患者（86%）达到了 R0 切除，另 1 例患者达到了 R2 切除。3 例患者在 1 年内发生肺部转移，其中 2 例很快死亡。其他 4 例患者在撰写本文时仍存活且无复发。
原发性纵隔卵黄囊瘤罕见，预后较差。包括辅助化疗后手术切除的多模式积极治疗方法是最佳治疗方法，可能导致长期生存。
