一位36歲男性以咳嗽及下肢無力表現

<p>臨床上，持續性咳嗽常會讓人聯想到上呼吸道、肺部或心臟血管疾病。本案例為一位36歲男性，因持續性咳嗽、呼吸喘等情形持續六個月未改善就醫，入院後初步臆測診斷為肺炎與疑似肺部惡性腫瘤，經胸部電腦斷層檢查、胸椎核磁共振檢查、血清腫瘤指數檢驗及肺部組織病理切片等報告，最後診斷為原發性前縱膈腔生殖細胞癌合併雙側肺部及胸椎轉移。予以多模式治療，如藥物治療、化學治療及放射治療後，症狀即獲得緩解並返家休養，後續於門診追蹤與治療。原發性前縱膈腔生殖細胞癌在性腺外生殖細胞癌中相當罕見，容易與肺炎、胸腺瘤、淋巴癌、或畸胎瘤混淆。因此藉此案例，讓臨床醫護人員如有發現前縱膈腔病灶，須將生殖細胞癌列為鑑別診斷並將其特徵謹記於心，並可提供臨床更多元之考量，避免錯失治療黃金時間。</p> <p> </p><p>In clinical practice, persistent coughing often raises concerns about upper respiratory, pulmonary,or cardiovascular diseases. This case involves a 36-year-old male who presented with a six-month history of persistent cough, dyspnea, and wheezing that failed to improve with prior treatment. Upon admission, the initial diagnoses included pneumonia and suspected pulmonary malignancy. A com-prehensive workup, including thoracic computed tomography (CT), magnetic resonance imaging (MRI) of the thoracic spine, serum tumor marker analysis, and lung tissue biopsy, ultimately confirmed a diagnosis of primary mediastinal non-seminomatous germ cell tumor with metastases to both lungs and the thoracic spine. The patient underwent multimodal treatment, including pharmacologic therapy, chemotherapy, and radiotherapy, which alleviated symptoms and allowed for discharge with outpatient follow-up and continued treatments. Primary germ cell tumors of the anterior mediastinum are rare and can be easily mistaken for pneumonia, thymoma, lymphoma, or teratoma. Hence, clinical staff should consider it in differential diagnosis to to avoid misdiagnosis and ensure timely intervention.</p> <p> </p>