治療巨大縱膈腔生殖細胞瘤的綜合治療方案：病例報告

Huge Mediastinal Yolk Sac Tumor: A Case Report

縱膈腔卵黃囊瘤是預後不佳的罕見異位性生殖細胞腫瘤。本病例為19歲男性，該腫瘤位於前縱隔和縱隔周圍，直徑17厘米，導致持續性乾咳和呼吸困難。腫瘤並侵犯胸壁、左下肺葉、心包、左膈神經。綜合治療方案包括放射治療、博萊黴素-依托泊苷-順鉑的改良化療、手術。患者在化療第一個週期對依托泊苷迅速出現過敏反應，症狀表現為面部紅潮和一般性不適。經靜脈液復蘇後，依托泊苷靜脈注射流速減半以保持化療的期望療效。儘管出現中性粒細胞減少和噁心等併發症，腫瘤被縮小並進行R2切除。病理報告確認被切除部分完全壞死且纖維化，無殘餘腫瘤細胞。5年追蹤期未見復發。本案例支持綜合治療方案的療效，以及調整化療方案以有效處理過敏反應的重要性。

Yolk sac tumor (YST) is a rare and aggressive subtype of nonseminomatous germ cell tumor with a poor prognosis. This case report presents the successful treatment of a primary mediastinal YST in a 19-year-old male. The tumor, located in the anterior mediastinum and surrounding structures, measured 17 cm in diameter and caused persistent dry cough and dyspnea. It had invaded the chest wall, the left lower lobe of the lung, and the pericardium. The integrated treatment approach included radiotherapy, modified chemotherapy with bleomycin, etoposide, and cisplatin, followed by surgical excision. During the first chemotherapy cycle, the patient experienced an immediate hypersensitivity reaction to etoposide, characterized by facial erythema and general discomfort. After intravenous fluid resuscitation, the infusion rate of etoposide was reduced by half to maintain chemotherapy efficacy. Serum levels ofα-fetoprotein (AFP) and lactate dehydrogenase (LDH) decreased significantly after chemotherapy. Despite complications such as neutropenia and postoperative nausea, the tumor shrank and was subsequently removed via debulking surgery. Intraoperatively, tumor invasion into the left phrenic nerve was observed. Pathological examination revealed necrosis and fibrous adhesion in the resected tumor, with no residual tumor cells detected. No postoperative complications were reported, and no tumor recurrence was observed during a five-year follow-up. The favorable outcome in this case supports the efficacy of the integrated treatment protocol and highlights the importance of adapting chemotherapy regimens to manage hypersensitivity reactions effectively.