Abstract
Primary mediastinal choriocarcinoma is characteristically seen in young males presenting with the symptomes of cough, chest pale, and gynccomastia. A 33-year-old woman was admitted to the hospital because of severe dyspnea and chest pain which was aggravated rapidly 2 or 3 days ago. Posterior mcdiastinal mass measuring about 1 cm in diameter was seen in Chest P-A, left lateral view of chest, and chest CT. Serum $\beta$-HCG level was markedly elevated up to 200, 000 mIxt. Whole body CT and other studies could not find any lesion on ovary and uterus. But, a single nodule nEeasuring about 1 cm in diameter was identified in the brain CT. The tumor cells (syncytiotrophoblastic cells) from resected mass revealed positivity on i histochemical staining for $\beta$-HCG. She was treated with EMA-CO after resection of tumor, But, 7 months later, she was readmitted and showed cerebral hemorrhage due to metastatic choriocarcinoma. She was operated again for the brain tumor, and was doing well for further 7 months.
원발성으로 종격동에서 발생한 융모막암종은 드문 질환으로 젊은 남자에서 주로 발견되었으며, 기침, 흉통, 여성형 유방 등의 증상을 보이는 것으로 알려졌다. 33세 여자로 약 3개월 전부터 가벼운 기침으로 시작하였으나 심한 호흡곤란과흉통증 등 증상이 급격히 악화되어 내원하였다. 방사선학적 검사상 후종격에서 직경 13cm크기의 종양이 발견되었고, 혈중 $\beta$-HCG가 20만 mIU 이상 증가하였으며, 적출된 종양은 $\beta$-HCG에 대한 면역조직화학적 검사상 양성반응을 보였다. 융모막암종 절제술을 받고 EMA-CO투여 받은후 약 7개월만에 뇌에 전이된 종양 때문에 뇌출혈을 일으켜 다시 뇌종양 적출술을 받았다. 환자는 그 후 약 7개월동안 두통외의 증상은 없었고 흉부단순촬영상 종격종양의 재발소견도 없었다.