Hu Tianjiao, Wu Qizi, Li Jian, Li Tao, Xu Jin, Zhou Li
Department of Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China.
Department of Hematology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Transl Pediatr. 2024 Aug 31;13(8):1496-1502. doi: 10.21037/tp-24-124. Epub 2024 Aug 27.
Primary mediastinal choriocarcinoma (PCC) is a rare, highly vascular invasive, and prognostically unfavorable malignant tumor. When occurring outside the gonads, primary choriocarcinoma is commonly found in midline locations such as the mediastinum or retroperitoneum. Currently, there is no standardized treatment strategy for PCC. In the case reported herein, we employed tislelizumab and chemotherapy in the treatment of a patient with PCC, and as in March 2024, the patient remained survive.
A 15-year-old boy who presented with symptoms of fever and cough for a year. Chest computed tomography (CT) scan showed a relatively large soft tissue shadow in the right upper anterior mediastinum, measuring approximately 5.4 cm × 3.8 cm. The patient's soft tissue exhibited unclear demarcation from surrounding mediastinal structures and was accompanied by lung metastasis. The patient underwent a fine needle aspiration biopsy for a mediastinal mass, and the pathology results indicated a germ cell tumor with solid malignant components in the mediastinum, along with pulmonary metastasis of the solid malignancy. The patient's serum levels of beta-human chorionic gonadotropin (β-HCG) were elevated at 125,554 mIU/mL (normal range: <5 mIU/mL), and alpha-fetoprotein (AFP) was 75.8 ng/mL (normal range, 0.605-7 ng/mL). The patient's cranial magnetic resonance imaging (MRI) plain scan indicated multiple scattered abnormal signals in both cerebral hemispheres. Subsequently, the patient was transferred to Children's Hospital of Nanjing Medical University for his further treatment. During the treatment period, we employed various therapeutic approaches, including chemotherapy, radiotherapy and tislelizumab therapy. After five cycles of tislelizumab treatment, the patient's symptoms of cerebral edema significantly improved, β-HCG levels decreased. Brain MRI of the patient revealed multiple abnormal signals within the skull, with some lesions showing reduction in size and significant improvement in the surrounding edema zones. The clinical symptoms of the patient improved and he achieved partial remission (PR). At the moment, the patient is living with the disease.
The effectiveness of chemotherapy for PCC is limited. Tislelizumab may potentially serve as salvage treatment options for PCC.
原发性纵隔绒毛膜癌（PCC）是一种罕见的、具有高度血管侵袭性且预后不良的恶性肿瘤。原发性绒毛膜癌发生在性腺外时，通常见于纵隔或腹膜后等中线部位。目前，PCC尚无标准化的治疗策略。在本文报道的病例中，我们采用替雷利珠单抗联合化疗治疗一名PCC患者，截至2024年3月，该患者仍存活。
一名15岁男孩，出现发热和咳嗽症状1年。胸部计算机断层扫描（CT）显示右上纵隔前部有一个相对较大的软组织阴影，大小约为5.4 cm×3.8 cm。患者的软组织与周围纵隔结构分界不清，并伴有肺转移。患者接受了纵隔肿块细针穿刺活检，病理结果显示纵隔内为伴有实性恶性成分的生殖细胞肿瘤，同时存在实性恶性肿瘤的肺转移。患者血清β-人绒毛膜促性腺激素（β-HCG）水平升高至125554 mIU/mL（正常范围：<5 mIU/mL），甲胎蛋白（AFP）为75.8 ng/mL（正常范围，0.605 - 7 ng/mL）。患者的头颅磁共振成像（MRI）平扫显示双侧大脑半球有多个散在异常信号。随后，患者转至南京医科大学附属儿童医院进一步治疗。治疗期间，我们采用了多种治疗方法，包括化疗、放疗和替雷利珠单抗治疗。经过5个周期的替雷利珠单抗治疗后，患者的脑水肿症状明显改善，β-HCG水平下降。患者的脑部MRI显示颅骨内有多个异常信号，部分病灶体积缩小，周围水肿带明显改善。患者的临床症状改善，达到部分缓解（PR）。目前，该患者仍带瘤生存。
化疗对PCC的疗效有限。替雷利珠单抗可能作为PCC的挽救治疗选择。
