Primary Germinal Cell Tumor (GCT) of the Mediastinum: Case report

Background: The medastinum is the most common location of primary germinal cell tumor and it accounts for about 10-15% of mediastinal masses in adults. Most patients are men- male to female ratio is 9: 1. Malignant tumors include seminomas and nonseminomas tumors. Nonseminomatous GCTs respond to chemotherapy but the prognosis is poorer than in case of seminomas. Primitive embryonic tumors situated in mediastinum give early clinical symptoms connected with quick growth and pressure on organs important for life. Prognoses for these locations are worse than for others. Case report: We report a case of a 32-year-old male patient with shortness of breath and superior vena cava syndrome. Chest radiograph revealed an enlargement of the mediastinum. Multislice CT scan showed heterogeneous mass in the anterior mediastinum with solid components and central necrosis. The biopsy of nodule revealed Primary Germinal Cell Tumor with increased AFP and hCG markers. After the first course of chemotherapy the patient's condition had improved, but after four courses they decided on thoracotomy and resection of residual mass. The final histopathologic diagnosis was Teratoma Mature and Teratoma Immature with suspicion of positive surgical margin. Consequently, they decided on two courses of chemotherapy, gaining the regression of mediastinal mass. Patient remains under observation. Conclusions: Large size of Primary Germinal Cell Tumor implies malignancy. After chemotherapy the tumor may reflect residual mass with fat and fibrous component. The MSCT is a necessary method for monitoring dynamics of changes in the course of chemical treatment.