上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

46例纵隔原发性生殖细胞肿瘤的临床病理学分析

高玉平1，刘强2，陈以明2   

  1. 上海交通大学 医学院附属仁济医院 1.生殖医学中心上海市辅助生殖与优生重点实验室， 2.病理科， 上海 200127
  • 出版日期:2015-05-28 发布日期:2015-06-04
  • 作者简介:高玉平（1967—）， 女， 副主任医师， 博士; 电子信箱: ginagao53@yahoo.com。
  • 基金资助:

    上海市科委基金（134119a9502，12DZ2260600）

Clinicopathological analysis of 46 cases of primary mediastinal germ cell tumors

GAO Yu-ping1, LIU Qiang2, CHEN Yi-ming2   

  1. 1.Shanghai Key Laboratory for Assisted Reproduction and Reproductive GeneticsCenter for Reproductive Medicine, 2.Department of Pathology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2015-05-28 Published:2015-06-04
  • Supported by:

    Foundation of Science and Technology Commission of Shanghai Municipality，134119a9502，12DZ2260600

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摘要：

目的 探讨原发性纵隔生殖细胞肿瘤（PMGCTs）的临床病理学特点。方法 收集46例PMGCTs患者的临床资料，对临床特点和病理学特征进行回顾性分析。结果 46例PMGCTs患者，男性24例，女性22例，平均年龄29.1岁。女性患者的病理学诊断均为成熟性畸胎瘤，恶性生殖细胞肿瘤的患者均为男性。PMGCTs患者的主要临床表现为胸痛、咳嗽、胸闷、气促、发热等。46例患者中，成熟性畸胎瘤34例（73.9%），精原细胞瘤4例（8.7%），卵黄囊瘤3例（6.5%），未成熟畸胎瘤2例（4.3%），混合性生殖细胞肿瘤2例（4.3%），恶性畸胎瘤1例（2.2%）。肿瘤组织免疫组织化学染色PLAP、OCT3/4、CD117、CK、CD30及LCA表达检测有助于诊断和鉴别诊断。随访发现，成熟性畸胎瘤和精原细胞瘤患者的5年生存率为分别为100%和75%，恶性畸胎瘤、卵黄囊瘤及混合性生殖细胞肿瘤患者的预后较差。结论 PMGCTs患者性别与肿瘤的组织学类型密切相关。成熟性畸胎瘤最常见，精原细胞瘤和卵黄囊瘤为常见的恶性生殖细胞肿瘤类型。与非精原细胞瘤性恶性生殖细胞肿瘤比较，精原细胞瘤患者预后较好，可能与其对放射治疗和化学治疗敏感有关。

关键词: 原发性纵隔生殖细胞肿瘤, 生殖细胞肿瘤, 性腺外, 免疫组织化学

Abstract:

Objective To investigate the clinicopathological features of primary mediastinal germ cell tumors (PMGCTs). Methods A total of 46 patients with PMGCTs were selected and their clinicopathological features were retrospectively analyzed. Results Among 46 patients with PMGCTs, 24 of them were male and 22 of them were females and the median age was 29.1. All 22 female patients were diagnosed with mature teratoma. All patients with malignant GCTs were male. Main clinical manifestations were chest pain, cough, dyspnea, and fever. Among 46 patients, there were 34 patients with mature teratoma (73.9%), 4 patients with seminoma (8.7%), 3 patients with york sac tumor (6.5%), 2 patients with immature teratoma (4.3%), 2 patients with mixed GCTs (4.3%), and 1 patient with malignant teratoma (2.2%). Immunohistochemical markers PLAP, OCT3/4, CD117, CK, CD30 and LCA were helpful for accurate diagnosis and differential diagnosis of PMGCTs. Follow-ups showed that the 5-year overall survival rates of patients with mature teratoma and seminoma were 100% and 75%, respectively. The prognosis of malignant teratoma, york sac tumor, and mixed GCTs was poor. Conclusion The gender of patients with PMGCTs is closely correlated with histological types of PMGCTs. Mature teratoma is the most common type. Seminoma and york sac tumor are common types of malignant GCTs. Compared with malignant GCTs other than seminoma, the prognosis of seminoma is much better, which may be relevant to being sensitive to radiotherapy and chemiotherapy.

Key words: primary mediastinal germ cell tumors, germ cell tumors, extragonadal, immunohistochemistry