【病例】前纵隔生殖细胞瘤1例CT影像表现

History: An otherwise healthy young man presents with discomfort.

病史:青年男性,原本健康,现身体不适。

Chest radiographs and CT images are shown below.

胸部平片及CT图像如下所示。

【病例】前纵隔生殖细胞瘤1例CT影像表现

【病例】前纵隔生殖细胞瘤1例CT影像表现

【病例】前纵隔生殖细胞瘤1例CT影像表现

【病例】前纵隔生殖细胞瘤1例CT影像表现

【病例】前纵隔生殖细胞瘤1例CT影像表现

Findings

Initial chest radiographs demonstrate a large anterior mediastinal mass, which on CT is shown to be a soft-tissue mass,which is encasing vessels and severely compressing the superior vena cava (SVC). On follow-up chest CT, a hypervascular lesion is seen within the left lobe of the liver with a direct connection to the venous collaterals associated with SVC obstruction.

胸片示一巨大前纵隔肿物,在CT上表现为软组织肿块,包绕血管并明显压迫上腔静脉。肝左叶可见一富血供病变,其直接与静脉侧支相连,与上腔静脉闭塞有关。

Differential diagnosis

Anterior mediastinal mass in a young man

  • Lymphoma
  • Germ cell tumor
  • Thymoma, thymic carcinoid or thymic carcinoma
  • Thyroid goiter

Hypervascular liver lesion

  • Vascular shunting
  • Hypervascular metastasis
  • Primary hypervascular liver tumor such as focal nodular hyperplasia, adenoma, or hepatocellular carcinoma

鉴别诊断

青年男性前纵隔肿物:

  • 淋巴瘤
  • 生殖细胞瘤
  • 胸腺瘤、胸腺类癌或胸腺癌
  • 甲状腺肿

肝脏富血供病变:

  • 血管分流
  • 富血供转移瘤
  • 原发性肝脏富血供肿瘤(FNH、腺瘤、肝细胞癌)

Diagnosis: 

Anterior mediastinal germ cell tumor

The hypervascular left lobe liverlesion is a “pseudolesion” caused by shunting through inferiorepigastric venous collateral running through the liver secondary to SVCobstruction.

最后诊断:前纵隔生殖细胞瘤

肝左叶富血供病变是一个“假性病变”,是由上腔静脉闭塞所致的腹壁下静脉穿行于肝脏形成的血管分流。

Key points

Mediastinal germ cell tumors

  • Teratomas are the most common mediastinal germ cell tumor (70%); seminomatous and nonseminomatous tumors are less common.
  • Teratomas are divided into mature and immature subgroups.
  • Teratomas are often multicystic and commonly contain fat and/or calcification.
  • Seminomas are typically homogeneous and calcification is rare.
  • Nonseminomatous germ cell tumors are often ill-defined with regions of necrosis.

前纵隔生殖细胞瘤

  • 畸胎瘤是最常见的前纵隔生殖细胞瘤(70%),精原细胞瘤和非精原细胞瘤相对少见。
  • 畸胎瘤可分为成熟型和不成熟型。
  • 畸胎瘤通常是多囊性,常包含脂肪和/或钙化。
  • 精原细胞瘤典型表现为病变密度均匀,钙化罕见;
  • 非精原细胞型生殖细胞瘤常表现病变边界不清,内可见坏死区。

Hypervascularliver lesions

Arterial-phase imaging through theliver in a patient with SVC obstruction can produce hypervascular”pseudolesions” in the left liver lobe via collaterals involvinginferior epigastric veins that course through the liver.

富血供肝脏病变

上腔静脉梗阻的患者增强扫描动脉期在肝左叶可见富血供的“假性病变”,可见与腹壁下静脉间形成的侧支循环穿过肝实质。

知识点图解

【病例】前纵隔生殖细胞瘤1例CT影像表现

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