心タンポナーデを来した前縦隔原発混合型胚細胞腫瘍の１剖検例

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We report an unusual autopsy case of a 4-year-old girl with acute cardiac tamponade resulting from a primary anterior mediastinal mixed germ-cell tumor that penetrated the pericardial sac. The patient was admitted for the evaluation of symptoms of nocturnal fever, cough, facial edema, and superior vena cava syndrome.She was found to have a large anterior mediastinal mass 10 cm in diameter on chest radiographs. Serological examination showed highly elevated serum alpfa-fetoprotein with normal human chorionic gonadotropin. Immediately following admission she was treated with combination chemotherapy in addition to irradiation,but she developed sudden dyspnea and died 4 days later.At autopsy,histology of the large mass occupying the anterior mediastinum exhibited a combined germ-cell tumor of mature cystic teratoma and yolk-sac tumor with extensive hemorrhage and necrosis. Immunohistochemically,yolk-sac tumor elements were strongly positive for alpha-fetoprotein. Intrathoracic invasion and metastasis were observed in the pericardium, superior vena cava,and bilateral lungs.The sudden death was apparently due to acute cardiac tamponade following bleeding from the lesions of both pericardial invasion and heavy circulatory disturbance by yolk-sac tumor elements.
信州医学会の論文
1999-12-10