Poor Outcomes in Patients with Primary Malignant Mediastinal Germ-Celia Tumors

原發性縱隔腔生殖芽細胞惡性腫瘤病人具不良之預後

蕭惠樺(Hui-Hua Hsiao) ； 劉益昌(Yi-Chang Liu) ； 蔡慧珍(Hui-Jen Tsai) ； 蔡坤寶(Kun-Bow Tsai) ； 鄭裕仁(Yu-Jen Cheng) ； 周世華(Shah-Hwa Chou) ； 鍾飲文(Inn-Went Chong) ； 楊文棋(Won-Chi Yang) ； 劉大智(Ta-Chi Liu) ； 林勝豐(Sheng-Fung Lin)

《The Kaohsiung Journal of Medical Sciences》 21卷11期 (2005/11) Pp. 561-565

摘要

無生殖腺體侵犯之原發性縱膈腔生殖芽細胞腫瘤為罕見之腫瘤，一般分為良性成熟畸胎瘤及包含精細胞瘤和非精細胞瘤在內的惡性腫瘤。在此我們報告惡性縱膈腔生殖芽細胞腫瘤之病患，並和成熟畸胎瘤比較其臨床表現和預後。共有包括一位精細胞瘤、一位絨毛膜癌及兩位卵黃囊瘤在內的四位惡性生殖芽細胞腫瘤的病人於本院治療。此四位病患均為男性成人且皆有明顯之症狀。精細胞瘤的病患以手術加上放射線治療；而其他的非精細胞瘤病患則以化學治療加上開刀治療為主。共有兩位病患死亡，包括一位病患有廣泛的肺部轉移和另一位是有高的腫瘤指數復發病患。和其他九位成熟畸胎瘤病人比較，惡性生殖芽細胞腫瘤的病人有顯著的男性病患傾向，明顯的症狀及較差的預後。這些例子強調疾病晚期和腫瘤指數對惡性生殖芽細胞腫瘤病患預後的重要影響；也認為對惡性生殖芽細胞腫瘤的治療須有更多的研究。

關鍵字

惡性生殖芽細胞腫瘤 ； 縱膈腔 ； 畸胎瘤 ； 精細胞瘤 ； 卵黃囊瘤

並列摘要

Primary mediastinal germ-cell tumors (GCTs) without gonadal involvement are rare and can be divided into benign mature teratoma and malignant seminoma or nonseminoma. We describe our experience of malignant mediastinal GCTs and compare the presentations and outcome with those of benign teratomas. Four malignant GCTs (1 seminoma, 1 choriocarcinoma, and 2 yolk-sac tumors) have been treated in our hospital. All patients were men with obvious symptoms before diagnosis. The patient with seminoma was treated with surgery and radiation, while those with nonseminoma tumors were treated with chemotherapy and/or surgery. Two patients died, one with extended pulmonary metastasis and the other with relapsed disease and high levels of tumor markers. Compared with the nine cases of benign teratomas, the four malignant GCTs showed overwhelming male dominance, advanced symptoms at presentation, and poor outcome. These cases highlight the important role of disease staging and tumor-marker levels in malignant GCTs, and suggest that new treatment strategies for malignant GCTs await further investigation.

並列關鍵字

malignant germ-cell tumor ； mediastinum ； teratoma ； seminoma ； yolk sac tumor