Kaneki T, Hachiya T, Hayano T, Koizumi T, Kubo K, Harada T, Kawashima A, Sekiguchi M, Honda T, Maruyama Y
First Department of Internal Medicine, Shinshu University School of Medicine, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Apr;35(4):414-9.
An 18-year man was admitted to the hospital because of acute dyspnea. Roentgenological examination revealed a large anterior mediastinal tumor. Histologic examination of a specimen from a cervical lymph node yielded a diagnosis of non-Hodgkin's lymphoma of, diffuse, large, T-cell type. Acute respiratory failure and a massive pleural effusion developed, and mechanical ventilation was begun. Chemotherapy with adriamycin, vincristine, cyclophosphamide, and prednisolone resulted in rapid shrinking of the mass. Acute renal failure developed because of hypoperfusion of the kidney caused by acute circulatory failure and the tumor lysis syndrome, and rapid increases in the concentrations of lactate dehydrogenase, creatine phosphokinase, and uric acid in serum after the tumor collapsed. Mediastinal malignant lymphoma often forms a bulky mass, and effective chemotherapy, while it can prolong survival, may also cause the tumor lysis syndrome.
一名18岁男性因急性呼吸困难入院。X线检查发现前纵隔有一个大肿瘤。对颈部淋巴结标本进行组织学检查，诊断为弥漫性大T细胞型非霍奇金淋巴瘤。随后出现急性呼吸衰竭和大量胸腔积液，遂开始机械通气。使用阿霉素、长春新碱、环磷酰胺和泼尼松龙进行化疗后，肿块迅速缩小。由于急性循环衰竭和肿瘤溶解综合征导致肾脏灌注不足，肿瘤消退后血清中乳酸脱氢酶、肌酸磷酸激酶和尿酸浓度迅速升高，进而发生急性肾衰竭。纵隔恶性淋巴瘤常形成巨大肿块，有效的化疗虽可延长生存期，但也可能引发肿瘤溶解综合征。
