Rampengan Vicky Reinold Christofel, Bakhtiar Arief
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Int J Surg Case Rep. 2022 Aug;97:107478. doi: 10.1016/j.ijscr.2022.107478. Epub 2022 Aug 3.
Primary mediastinal seminoma is rare, especially with complications of superior vena cava syndrome (VCSS) and large thrombus.
A 23-years-old Indonesian male complained of dyspnea, phlegm cough, chest pain, and body weight loss. The patient experienced swelling in the face and neck 1 week ago, accompanied by increased jugular venous pressure. Radiological results showed a firm mass in the right area of the mediastinum. Tumor marker and IHC results showed mediastinal seminoma. Electrocardiography showed sinus tachycardia, right axis deviation, and V1-V5 slow R wave progression. Echocardiography showed an intracardiac mass (RA protrusive RV, size 7.2 × 3.8 cm) with an intracardiac thrombus and RV failure. The patient was positioned in a semi-Fowler's position and given furosemide 3 × 20 mg, dexamethasone 3 × 5 mg, and warfarin 1 × 4 mg. Meanwhile, the results of the biopsy revealed a malignant germ cell tumor. When the patient was going to have bronchoscopy and radiotherapy planned, the patient died.
Reporting primary mediastinal seminoma cases with complications of VCSS and large thrombus has a high risk of mortality, so this report can be used as a review to improve management in future.
Mediastinal seminoma with complications has a high mortality.
原发性纵隔精原细胞瘤罕见，尤其是伴有上腔静脉综合征（VCSS）和大血栓形成等并发症时。
一名23岁的印度尼西亚男性，主诉呼吸困难、咳痰、胸痛及体重减轻。患者于1周前出现面部和颈部肿胀，伴有颈静脉压升高。影像学检查结果显示纵隔右侧区域有一实性肿块。肿瘤标志物及免疫组化结果显示为纵隔精原细胞瘤。心电图显示窦性心动过速、电轴右偏及V1 - V5导联R波递增不良。超声心动图显示心内肿块（右心房突入右心室，大小7.2×3.8cm），伴有心内血栓及右心室功能衰竭。患者采取半卧位，给予呋塞米3×20mg、地塞米松3×5mg及华法林1×4mg。同时，活检结果显示为恶性生殖细胞肿瘤。当患者准备进行支气管镜检查及放疗时，患者死亡。
报告伴有VCSS和大血栓形成并发症的原发性纵隔精原细胞瘤病例死亡率高，因此本报告可作为回顾资料，以改进未来的治疗管理。
伴有并发症的纵隔精原细胞瘤死亡率高。
