Original reportsAnterior mediastinal nonseminomatous germ cell tumor with malignant transformation: A case report
Introduction
Primary neoplasms of the anterior mediastinum are a rare occurrence; nonseminomatous germ cell tumors (NSGCT) account for a small percentage of these. In a review of 702 cases of primary anterior mediastinal tumors in adults, 47% were thymic tumors (primarily thymomas), 22% were lymphomas, 16% were endocrine tumors, and 15% were germ-cell tumors.1 Each of these clinical entities varies in their presentation, diagnosis, treatment, and prognosis. Thymoma may present with symptoms of a paraneoplastic syndrome, such as myasthenia gravis, hypogammaglobulinemia, or pure red cell aplasia; is usually diagnosed with fine needle aspiration (FNA) biopsy; and is generally cured with complete surgical excision.2 Lymphoma should be diagnosed with excisional biopsy but is treated with chemotherapy.3 Germ cell tumors represent a spectrum of the disease process ranging from benign encapsulated masses to extremely aggressive invasive neoplasms. This case report illustrates an unusual presentation of a rare benign primary mediastinal germ cell tumor, which after appropriate neoadjuvant treatment, progressed to malignant degeneration with metastases.
Section snippets
Case report
A previously healthy 20-year-old Hispanic man presented to the Emergency Department with complaints of 1 week of intermittent nausea, fatigue, orthopnea, and minimal dysphagia. The remainder of his medical history was unremarkable. His physical examination revealed a generally healthy appearing young man with no signs of superior vena cava syndrome, no lymphadenopathy, and no abnormalities on genital examination. Significant positive findings included distant heart sounds as well as bilateral
Discussion
The anterior mediastinum is the most common extragonadal site for germ cell tumors.7 These tumors account for only 5% of the 7000 germ cell tumors identified each year in the United States,8with approximately 85% benign. Germ cell neoplasms are classified as either seminomatous or nonseminomatous. Nonseminomatous are further subclassified into embryonal, yolk sac (endodermal sinus), teratocarcinoma, choriocarcinoma, or mixed. Overall, 15% of germ cell tumors have malignant potential, the
References (17)
- et al.
Primary anterior mediastinal tumors in children and adults
Ann Thorac Surg
(1986) Chemotherapeutic and surgical strategies for germ cell tumors
Chest Surg Clin N Am
(2002)- et al.
Primary mediastinal tumors. Part 1tumors of the anterior mediastinum
Chest
(1997) Mediastinal germ cell tumorsclinical features and biologic correlates
Chest
(1991)Diagnosis,staging, and clinical characteristics of the patient with mediastinal germ cell carcinoma
Chest Surg Clin N Am
(2002)- et al.
Surgical techniques and outcomes for primary nonseminomatous germ cell tumors
Chest Surg Clin N Am
(2002) - et al.
Primary mediastinal nonseminomatous germ cell tumors. Results of a multimodality approach
J Thoracic Cardiovasc Surg
(1990) - et al.
Primary mediastinal nonseminomatous germ cell tumorsthe influence of postchemotherapy pathology on long-term survival after surgery
J Thorac Cardiovasc Surg
(1999)
Cited by (0)
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the United States Government, the Department of Defense, or the United States Air Force.