Adenocarcinoma Arising from Anterior Mediastinal Teratoma Controlled with Concurrent Chemoradiothreapy

前縱膈腔畸胎瘤惡性轉變成腺癌以同步化電療治療

10.6323/JoCRP.2011.27.1.4

王韋淯(Wei-Yu Wang)；蘇五洲(Wu-Chou Su)

縱膈腔畸胎瘤 ； 畸胎瘤惡性轉變 ； 腺癌 ； 同步化電療 ； mediastinal teratoma ； teratoma with malignant transformation ； adenocarcinoma ； CCRT

台灣癌症醫學雜誌

27卷1期（2011 / 02 / 01）

25 - 30

英文

前縱膈腔畸胎瘤惡性轉變成腺癌是少見的疾病。我們報告一個37歲女性在就醫前已有右臉腫脹及活動性呼吸困難一個月。胸部電腦斷層顯示前縱膈腔有一個5.5公分的不均勻腫瘤，其中含有鈣化及脂肪成分，並縱膈腔淋巴結轉移及上腔靜脈壓迫。腫瘤指數皆在正常標準內。在縱膈腔腫瘤切片後，在病理組織中看見腺癌伴隨著成熟軟骨組織，確定診斷為畸胎瘤惡性轉變為腺癌。我們施打BEP（bleomycin, etoposide, cisplatin）作為第一線化學治療，然而追蹤之斷層掃描卻顯示疾病進展，故改以cisplatin與5-FU同步化電療治療。在同步化電療後，病人病情達到疾病穩定並心包膜積液減少且呼吸困難改善。因縱膈腔畸胎瘤惡性轉變成腺癌非常少見，目前未有建立好之治療準則。我們報告同步電療加上cisplatin 與5-FU之化療在疾病控制上有不錯的效果。

Teratomas with malignant transformation and adenocarcinoma arising from anterior mediastinal teratoma are rare diseases. We report a 37-year-old woman presented with right facial swelling and dyspnea on exertion for one month before admission. Chest computed tomography scan revealed a 5.5-cm anterior mediastinal heterogeneous tumor with calcification and a fat nodule. The tumor had metastasized to mediastinal lymph nodes and compressed superior vena cava. All the tumor markers checked were within normal limits. The pathology report of tumor biopsy showed teratoma with malignant transformation to adenocarcinoma. The tumor cells did not harbor epidermal growth factor receptor (EGFR) mutations. We gave the patient chemotherapy with BEP (bleomycin, etoposide, cisplatin) as first-line therapy. Because of disease progression, we used radiotherapy plus chemotherapy with cisplatin and 5-FU. After the concurrent chemoradiotherapy, the patient achieved a stable disease with reduction of pericardial effusion and dyspnea. Because mediastinal teratoma with adenocarcinoma transformation is rare, there is no well-established guideline for the patient management. We report here that concurrent radiotherapy plus chemotherapy with 5-FU and cisplatin produced good disease control.