Mediastinal Yolk Sac Tümörüne Bağlı Sağ Atriyum Kompresyonu Sonucunda Gelişen Sekonder Triküspit Stenoz: Olgu Sunumu
Özet
Mediastinal germ hücreli tümörler, komşu yapılara bası oluşturarak çeşitli klinik bulgulara yol açabilen nadir ekstragonadal malignitelerdir. Kardiyak yapıların etkilenmesi ise daha seyrek görülmekte olup ciddi hemodinamik sonuçlara neden olabilmektedir. Bu olgu sunumunda, mediastinal yerleşimli yolk sac tümörüne bağlı sağ atriyum kompresyonu sonucunda sekonder triküspit stenoz gelişen 22 yaşındaki erkek hasta sunulmuştur. Ani kötüleşen dispne nedeniyle yapılan transtorasik ekokardiyografide sağ atriyuma dıştan bası yapan kitlenin fonksiyonel triküspit stenoz oluşturduğu saptanmıştır. Sistemik kemoterapi sonrasında hem kardiyak kompresyon hem de triküspit stenoz bulgularının tamamen gerilediği izlenmiştir. Bu olgu, mediastinal kitleli hastalarda açıklanamayan dispne varlığında kardiyak kompresyonun ayırıcı tanıda değerlendirilmesi gerektiğini ve ekokardiyografinin tanısal önemini vurgulamaktadır.
Mediastinal germ cell tumors are rare extragonadal malignancies that can cause various clinical manifestations through compression of adjacent structures. Cardiac involvement is even less common but may lead to serious hemodynamic consequences. We present the case of a 22-year-old male patient who developed secondary tricuspid stenosis due to right atrial compression caused by a mediastinal yolk sac tumor. Transthoracic echocardiography performed because of sudden worsening dyspnea revealed an extracardiac mass compressing the right atrium and resulting in functional tricuspid stenosis. Following systemic chemotherapy, complete resolution of both the cardiac compression and tricuspid stenosis findings was observed. This case highlights the importance of considering cardiac compression in the differential diagnosis of unexplained dyspnea in patients with mediastinal masses and emphasizes the diagnostic value of echocardiography.
Referanslar
Lardinois D, Weder W. Diagnostic strategies in mediastinal mass. In: Pearson's Thoracic & Esophageal Surgery, 3rd ed, Patterson GA, Pearson FG, Cooper JD, et al (Eds), Churchill Livingstone, Elsevier, Philadelphia 2008. Vol 1, p.1506.
Shields TW. Overview of primary mediastinal tumors and cysts. In: General Thoracic Surgery, 6th ed, Shields TW, LoCicero III J, Ponn RB, Rusch VW (Eds), Lippincott Williams & Wilkins, Philadelphia 2005. Vol 2, p.2489.
Su, S., & Colson, Y. L. (2015). Overview of benign and malignant mediastinal diseases. David Sugarbaker. Adult Chest Surgery. Mc Graw Hill.
Ströbel, P., Chan, J. K. C., Looijenga, L. H. J., Marx, A., Moreira, A. L., Ulbright, T. M., & Wick, M. (2015). WHO classification of tumours of the lung, pleura, thymus and heart. In WHO classification of tumours (pp. 187-192). Lyon: IARC.
Moran, C. A., & Suster, S. (1997). Primary germ cell tumors of the mediastinum: I. Analysis of 322 cases with special emphasis on teratomatous lesions and a proposal for histopathologic classification and clinical staging. Cancer: Interdisciplinary International Journal of the American Cancer Society, 80(4), 681-690.
Takeda, S. I., Miyoshi, S., Akashi, A., Ohta, M., Minami, M., Okumura, M., ... & Matsuda, H. (2003). Clinical spectrum of primary mediastinal tumors: a comparison of adult and pediatric populations at a single Japanese institution. Journal of surgical oncology, 83(1), 24-30.
Weidner N. Germ-cell tumors of the mediastinum. Semin Diagn Pathol. 1999 Feb;16(1):42-50. PMID: 10355653.
Busch J, Seidel C, Zengerling F. Male Extragonadal Germ Cell Tumors of the Adult. Oncol Res Treat. 2016;39(3):140-4. doi: 10.1159/000444271. Epub 2016 Feb 23. PMID: 27032104.
9) Moran CA, Suster S, Koss MN. Primary germ cell tumors of the mediastinum: III. Yolk sac tumor, embryonal carcinoma, choriocarcinoma, and combined nonteratomatous germ cell tumors of the mediastinum--a clinicopathologic and immunohistochemical study of 64 cases. Cancer. 1997 Aug 15;80(4):699-707. PMID: 9264353.
Fizazi K, Culine S, Droz JP, Kramar A, Théodore C, Ruffié P, Le Chevalier T. Primary mediastinal nonseminomatous germ cell tumors: results of modern therapy including cisplatin-based chemotherapy. J Clin Oncol. 1998 Feb;16(2):725-32. doi: 10.1200/JCO.1998.16.2.725. PMID: 9469363.
Odeh, R., Dweekat, M. T., & Shakhshir, A. (2023). Germ Cell Tumor Complicated by Mediastinal Mass Syndrome: A Report of Cardiac Arrest to Full Recovery. Cureus, 15(10), e46445.
Schroeter T, Doll N, Subramanian S, Mohr FW, Borger MA. Massively dilated right atrium masquerading as a mediastinal tumor. Clin Pract. 2011 Apr 14;1(1):e20. doi: 10.4081/cp.2011.e20. PMID: 24765275; PMCID: PMC3981207.
Pini GM, Colecchia M. Mediastinal germ cell tumors: a narrative review of their traits and aggressiveness features. Mediastinum. 2022 Mar 25;6:5. doi: 10.21037/med-21-22. PMID: 35340833; PMCID: PMC8841550.
Ayundra MH, Laksmono N, Murni TW. A rare case of life-threatening mixed germ cell tumor infiltrating the heart: A case report. Int J Surg Case Rep. 2023 Jul;108:108385. doi: 10.1016/j.ijscr.2023.108385. Epub 2023 Jun 9. PMID: 37406535; PMCID: PMC10382750.
Sun ZY, Li Q, Li J, Zhang MW, Zhu L, Geng J. Echocardiographic evaluation of the right atrial size and function: Relevance for clinical practice. Am Heart J Plus. 2023 Feb 15;27:100274. doi: 10.1016/j.ahjo.2023.100274. PMID: 38511096; PMCID: PMC10945901.
D'Cruz IA, Feghali N, Gross CM. Echocardiographic manifestations of mediastinal masses compressing or encroaching on the heart. Echocardiography. 1994 Sep;11(5):523-33. doi: 10.1111/j.1540-8175.1994.tb01093.x. PMID: 10150628.
Albany C, Einhorn LH. Extragonadal germ cell tumors: clinical presentation and management. Curr Opin Oncol. 2013 May;25(3):261-5. doi: 10.1097/CCO.0b013e32835f085d. PMID: 23422328.
