Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China.
Graduate School, Hebei North University, Zhangjiakou, Hebei, China.
Medicine (Baltimore). 2021 Oct 29;100(43):e27617. doi: 10.1097/MD.0000000000027617.
Mediastinal non-seminomatous germ cell tumors (MNSGCTs) are rare malignancies. Chemotherapy followed by surgical resection has been regarded as the standard management, but treatment options for chemotherapy-refractory patients or those with unresectable tumors are limited, resulting in a very poor prognosis.
An 18-year-old female presented with symptoms of cough, chest tightness, and shortness of breath for 2 months, and the symptoms gradually worsened.
Computed tomography (CT) revealed a large mediastinal mass invading the pericardium and great blood vessels. Serum human chorionic gonadotropin (HCG) and α-fetoprotein (AFP) levels were normal. Histopathological examination of biopsy specimens revealed mixed MNSGCT with embryonal carcinoma and immature teratoma components.
The patient achieved complete remission (CR) and long-term survival after multimodal therapy comprising chemotherapy, positron emission tomography/CT (PET/CT)-guided volumetric-modulated arc therapy (VMAT), and anti-angiogenic targeted therapy.
The patient was followed up for more than 4 years without recurrence, metastasis, or treatment-related adverse effects.
The case presented here highlights the importance of multidisciplinary diagnosis and treatment, providing evidence that radiotherapy and anti-angiogenic therapy may play an important role in unresectable or residual tumors after failure of conventional treatments of MNSGCT. Percutaneous biopsy is necessary for diagnosis if the tumor is unresectable, and serum AFP and HCG levels are normal. Additionally, PET/CT is an effective method for evaluation of efficacy and radiotherapy guidance for patients with MNSGCTs.
纵隔非精原细胞瘤生殖细胞肿瘤（MNSGCTs）是罕见的恶性肿瘤。化疗后行手术切除被认为是标准治疗方法，但化疗耐药或不可切除肿瘤患者的治疗选择有限，导致预后极差。
一名 18 岁女性因咳嗽、胸闷和呼吸困难症状就诊，已持续 2 个月，且症状逐渐加重。
计算机断层扫描（CT）显示巨大纵隔肿块侵犯心包和大血管。血清人绒毛膜促性腺激素（HCG）和甲胎蛋白（AFP）水平正常。活检标本的组织病理学检查显示混合性 MNSGCT，具有胚胎癌和未成熟畸胎瘤成分。
患者接受了包括化疗、正电子发射断层扫描/CT（PET/CT）引导的容积旋转调强弧形治疗（VMAT）和抗血管生成靶向治疗在内的多模式治疗后达到完全缓解（CR）和长期生存。
患者随访超过 4 年，无复发、转移或治疗相关不良反应。
本例强调了多学科诊断和治疗的重要性，为不可切除或常规治疗失败后的残留肿瘤提供了放疗和抗血管生成治疗可能发挥重要作用的证据。对于不可切除的肿瘤，经皮活检有助于明确诊断，且血清 AFP 和 HCG 水平正常。此外，PET/CT 是评估 MNSGCT 患者疗效和放疗指导的有效方法。
