原发性纵隔恶性生殖细胞瘤2例并文献复习

目的 提高对原发性纵隔恶性生殖细胞瘤（primary malignant mediastinal germ cell tumor，PMMGCT）的认识。方法 回顾分析2例PMMGCT患者的临床资料，并检索复习文献。结果 病例1，男性，22岁，咳嗽、呼吸困难5个月，胸部CT显示前纵隔巨大肿物，血β-人绒毛膜促性腺激素（β-human chorionic gonadotropin，β-HCG）升高，超声引导穿刺病理为精原细胞瘤。病例2，男性，20岁，胸痛10 d，胸部CT显示前纵隔巨大肿物，血甲胎蛋白（α-fetoprotein，AFP）明显升高，CT引导穿刺病理为纵隔卵黄囊瘤。回顾文献，PMMGCT多见于青年男性，症状缺乏特异性，胸部CT可见巨大肿物多位于前纵隔，内部可见低密度囊性改变和钙化。精原细胞瘤血β-HCG升高，卵黄囊瘤血AFP明显升高。PMMGCT对化学药物治疗（以下简称化疗）敏感，首选含铂类的联合化疗，后可辅以手术或放射治疗清除残留病灶。结论 PMMGCT临床罕见，呼吸科和放射科医师应提高认识，为患者争取较好的预后。

Primary malignant mediastinal germ cell tumor: report of two cases and literature review

Objective To improve the recognition of primary malignant mediastinal germ cell tumor (PMMGCT). Methods We describe in detail the clinical data of 2 patients with PMMGCT, and reviewed the relevant literature. Results Patient 1, a 22-year-old man, presented with cough and dyspnea for 5 months. Chest CT showed a large homogeneous mass. Serum beta human chorionic gonadotrop(h)in (β-HCG) level was elevated. Ultrasound-guided biopsy confirmed seminoma. Patient 2, a 20 year-old man, presented with chest pain for 10 days. Chest CT showed a large heterogeneous mass, and his serum alpha-fetoprotein (AFP) level elevated significantly. CT-guided biopsy confirmed yolk sac tumor. PMMGCT is seen almost exclusively in young men. Symptoms usually are nonspecific. Chest CT often shows a large heterogeneous mass with obliteration of adjacent fat planes. Elevated serum AFP or β-HCG can be used as diagnostic clues. PMMGCT are highly sensitive to cisplatin-based chemotherapy, followed by radiotherapy or surgical resection. Conclusion PMMGCT patients are rarely seen clinically. Respiratory and radiological physicians should raise awareness and strive for a better prognosis.