Primary Mediastinal Choriocarcinoma Complicated by Acute Respiratory Distress Syndrome and Treated with Chemotherapy Administered under Extracorporeal Membrane Oxygenation: A Case Report and Literature Review

原發性縱隔腔絨毛膜癌併發急性呼吸道窘迫症候群，在葉克膜氧合器支持下接受化學治療：個案報告與文獻回顧

陳亨翔(Heng-Siang Chen) ； 李懌鑫(Yi-Hsin Lee) ； 吳耀光(Yao-Kuang Wu) ； 吳智偉(Chih-Wei Wu)

《胸腔醫學》 34卷2期 (2019/04) Pp. 82-91

摘要

Extragonadal choriocarcinoma is a rare malignancy that occurs mostly in men, and is usually diagnosed between 20 and 30 years of age. The definite pathogenesis of extragonadal choriocarcinoma has not been clarified. Most patients have elevated serum α-fetoprotein and elevated serum β-human chorionic gonadotropin at presentation. Extragonadal choriocarcinoma is characterized by multiple metastatic lesions at the time of diagnosis; it is refractory to antineoplastic therapy, and progresses rapidly. Supportive care is a rather reasonable choice for patients with a poor performance status. Some case series have described successful chemotherapy for patients with cancer suffering from acute respiratory failure under extracorporeal membrane oxygenation (ECMO) support. Nevertheless, these reports are almost all restricted to hematologic malignancies. We present the first case of a 20-year-old man who was diagnosed with primary mediastinal choriocarcinoma and received chemotherapy under ECMO support.

關鍵字

primary mediastinal choriocarcinoma ； acute respiratory distress syndrome ； extracorporeal membrane oxygenation

並列摘要

性腺外絨毛膜癌是一種罕見的惡性腫瘤，大部分個案為男性。它的確切致病機轉目前仍不清楚。它的好發年齡為20至30歲的年輕男性。大部分的病患在罹病初期，血清中的甲型胎兒蛋白及乙型絨毛膜促性腺激素會顯著升高。它的病程進展迅速，在初診斷時常合併多處轉移，且對化學治療反應不佳。支持性治療對於體力不佳的病患來說是一個合理的選擇。文獻上，在併發急性呼吸窘迫症候群且需葉克膜氧合器支持的癌症病患，此時注射化學治療，有少數成功的個案報告。然而，幾乎這類型的個案皆為血液惡性腫瘤的患者。我們報告一位原發性縱隔腔絨毛膜癌的20歲男性年輕病患，在併發急性呼吸窘迫症候群且接受葉克膜氧合器支持的狀況下，文獻上第一位接受化學治療的個案。

並列關鍵字

原發性縱隔腔絨毛膜癌 ； 急性呼吸窘迫症候群 ； 葉克膜氧合器