Kanno R, Yanai K, Ohishi A, Noue H, Motoki R
First Department of Surgery, Fukushima Medical College, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Feb;45(2):213-9.
A 55-year-old male with multiple endocrine neoplasia syndrome accompanied by hyperparathyroidism and hypergastrinemia was admitted because of local recurrence of thymic carcinoid tumor and a parathyroid adenoma. The recurrent thymic carcinoid tumor replaced anterior mediastinum, invaded brachiocephalic vein and superior vena cava, a disseminated nodule was found at pericardium. After induction chemotherapy using carboplatin and etoposide the operation was performed. The parathyroid tumor and recurrent thymic carcinoid tumor were removed completely together with brachiocephalic vein, superior vena cava, pericardium and anterior chest wall. Superior vena cava was replaced with synthetic graft and chest wall was reconstructed. The patient is alive and well 22 months after surgery without recurrence. Immunohistochemistry of removed specimens revealed parathormone and gastrin secreted from the parathyroid adenoma but not from the carcinoid tumor. Careful survey of systemic endocrine organs is necessary in case of thymic carcinoid tumor. Aggressive surgery in locally recurrent thymic carcinoid without distant metastasis must be considered.
一名55岁男性，患有多发性内分泌肿瘤综合征，伴有甲状旁腺功能亢进和高胃泌素血症，因胸腺类癌肿瘤和甲状旁腺腺瘤局部复发入院。复发性胸腺类癌肿瘤取代了前纵隔，侵犯了头臂静脉和上腔静脉，在心包发现了一个播散性结节。使用卡铂和依托泊苷进行诱导化疗后进行了手术。甲状旁腺肿瘤和复发性胸腺类癌肿瘤与头臂静脉、上腔静脉、心包和前胸壁一起被完全切除。用上腔静脉人工血管替代上腔静脉，并重建胸壁。患者术后22个月存活良好，无复发。切除标本的免疫组织化学显示甲状旁腺腺瘤分泌甲状旁腺激素和胃泌素，而类癌肿瘤不分泌。对于胸腺类癌肿瘤患者，有必要仔细检查全身内分泌器官。对于无远处转移的局部复发性胸腺类癌，必须考虑积极手术。
