Stavros Daliakopoulos I*, Maria Stergianni, Grigorios Karagkiouzis, Antonella Koutela, Dimitrios Pappas, Christos Tsakalakis and Charalampos Martinos
Department of Cardiothoracic Surgery, Veterans Military Hospital of Athens, Metropolitan General Hospital, GreeceFulltext PDF
Introduction: Malignant germ-cell tumors are usually located in the gonads. Extragonadal germcell tumors are extremely rare and are typically located in midline structures and, especially, the anterior mediastinum. They are divided into seminomas and non-seminomatous germ cell tumors. The former is a radiosensitive tumor that can be successfully treated by surgery and radiation. The latter is a very rare category including: Yolk Sac Tumor (YST), Embryonal Carcinoma (EC), Choriocarcinoma (CC) and Combined Germs Cell Tumors (CGCTs). These tumors with relatively unknown clinical behavior are uncommon neoplasm of the mediastinum and only sporadic cases have been documented in the literature. Case Presentation: We report two male patients referred to our team with huge bulky tumors of the anterior mediastinum, infiltrating into adjacent anatomical structures for consultation and management. At the time of admission one of the patients presented with grossly edematous upper extremities and engorged cervical veins suggesting Superior Vena Cava (SVC) syndrome. The patients were treated surgically at first instance, for different medical reasons each, the unusual neoplasms with the different biologic behavior were totally excised or not, according to each case surgical demands and the systemic manifestations of the neoplasms were reversed. Conclusion: Malignant germ cell tumors are suspected among anterior mediastinal tumors affecting male patients of around 20 years old. Tumor markers must be investigated and tissue histology should be diagnosed for specimens obtained by mediastinoscopy or anterior mediastinotomy. In case of Non-Seminomatous Germ Cell Tumors (NSGCT) or a-Fetoprotein and/or humane Choriongonadotropin producing seminoma, the first choice remains chemotherapy. Means for surgical decision making are based only on dramatically worsening clinical indicators of SCV syndrome because initial debulking surgery is rarely useful.
Anterior mediastinum; Yolk sac tumor; Primary malignant Germ-Cell tumors
Stavros Daliakopoulos I, Stergianni M, Karagkiouzis G, Koutela A, Pappas D, Tsakalakis C, et al. Primary Malignant Germ-Cell Tumors of the Anterior Mediastinum in Adults Report of Two Rare Cases and Review of the Literature. Clin Surg. 2019; 4: 2518..