Shenoy Krithika Damodar, Stanzione Nicholas, Caron Justin E, Fishbein Gregory A, Abtin Fereidoun, Lluri Gentian, Hirschowitz Sharon L
Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California.
Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, California.
Diagn Cytopathol. 2019 Jun;47(6):594-598. doi: 10.1002/dc.24150. Epub 2019 Feb 8.
Nuclear protein in testis (NUT) midline carcinoma (NMC) is a rare and aggressive subset of poorly differentiated squamous cell carcinoma that is defined by t(15,19) and typically presents in the midline structures of the head, neck, and mediastinum. We report two cases of NMC that presented uniquely with malignant pleural and pericardial effusions including one with cardiac tamponade at presentation. The first case is of a 25-year-old male patient who presented with progressive dyspnea associated with palpitations and dizziness on standing, found to have large bilateral pleural effusions. The second case is of a previously healthy 29-year-old male patient who presented with progressive dyspnea, cough with expectoration, and a large right lower neck mass of 3 months onset, and a large left pleural effusion and left lung infiltrate on imaging studies. Both cases showed malignant cells on cytology suggestive of poorly differentiated carcinoma. Subsequent histopathological and immunochemistry studies were consistent with the diagnosis of NMC. Both patients had a rapid decline in status and suffered comorbidities secondary to their carcinoma, inevitably leading to their death. It is important to consider NUT midline carcinomas can present in a variety of clinical scenarios, and it is important to consider in the differential diagnoses when evaluating malignant effusion cytology. Utilization of ancillary testing with a broad immunostain profile including NUT studies, as well as fluorescent in-situ hydridization (FISH) studies are helpful and necessary in making the appropriate diagnosis.
睾丸核蛋白（NUT）中线癌（NMC）是低分化鳞状细胞癌中一种罕见且侵袭性强的亚型，由t(15,19)定义，通常出现在头、颈和纵隔的中线结构中。我们报告两例NMC，其独特表现为恶性胸腔和心包积液，其中一例在就诊时出现心脏压塞。第一例是一名25岁男性患者，表现为进行性呼吸困难，伴有心悸和站立时头晕，发现双侧大量胸腔积液。第二例是一名此前健康的29岁男性患者，表现为进行性呼吸困难、咳痰咳嗽，右颈下部有一个3个月起病的大肿块，影像学检查显示左侧大量胸腔积液和左肺浸润。两例细胞学检查均发现恶性细胞，提示低分化癌。随后的组织病理学和免疫化学研究与NMC诊断一致。两名患者病情迅速恶化，继发于癌症的合并症不可避免地导致了他们的死亡。重要的是要考虑到NUT中线癌可出现在各种临床情况中，在评估恶性积液细胞学检查时进行鉴别诊断时考虑到这一点很重要。使用包括NUT研究在内的广泛免疫染色谱的辅助检测以及荧光原位杂交（FISH）研究有助于并必要做出正确诊断。
