Large mixed germ cell tumor in a young patient presenting as an intrapulmonary mass

We present the case of a 26-year-old man with a bland medical history, who presented to the general practitioner because of severe cough and dyspnea. The chest X-ray revealed a massive organ-displacing tumor in the right chest not delineable from the mediastinum. The subsequent needle core biopsy was diagnostic for a mixed germ cell tumor comprising immature teratoma and seminoma. After an initially good response to chemotherapy, tumor markers and tumor size were progressive. The right-sided pneumonectomy revealed an intrapulmonary tumor with cystic and solid components, hemorrhage, and necrosis with a tumor diameter of 18 cm. Histology confirmed a teratoma with mature and immature components accompanied by residual seminomatous tumor cells. Despite maximal intensive care, the patient died four weeks after surgery from;cute respiratory distress syndrome. We describe this exceptional large intrapulmonary germ cell tumor and discuss the spectrum of such rare tumors. (C) 2009 Elsevier GmbH. All rights reserved.