心肺圧迫に伴う循環障害を来たし複数科による集学的治療を要した縦隔原発胚細胞腫瘍の1例

Abstract

A 28-year-old male presented to his physician with a chief complaint of fever and cough. Contrastenhanced computed tomography revealed a 17×16×8 cm heterogeneous tumor in the anterior mediastinum, as well as right heart and inferior vena cava compression due to the tumor. He was referred to our hospital for close examination and treatment. Alpha fetoprotein (AFP) was 24, 769 ng/ml, and percutaneous needle biopsy revealed a germ cell tumor with a York sac tumor component; therefore, Bleomycin, Etoposide and Cisplatin (BEP) therapy was started. Although AFP tended to decrease with BEP therapy, the tumor size remained unchanged, and right heart failure due to right heart system decompression led to cardiogenic shock. Consequently, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was introduced on Day 25. Since cardiogenic shock continued even after VA-ECMO, anterior mediastinal tumor resection was attempted on Day 30 following consultation with the respiratory surgery, cardiovascular surgery, cardiology, and intensive care units. Because the tumor was strongly adherent, tumor resection was abandoned, and tumor reduction surgery was performed. Postoperatively, his cardiovascular status improved quickly, and he was weaned off VA-ECMO the day after surgery. AFP decreased to 22 ng/ml but re-elevated; therefore, EP therapy was introduced on Day 97 when AFP was 600 ng/ml. We report a case of a primary mediastinal germ cell tumor with circulatory disturbance due to cardiopulmonary compression. In cases similar to ours, multidisciplinary treatment in collaboration with multiple departments is necessary.