A case of mediastinal germ cell tumor radically operated on after neoadjuvant chemotherapy-combined resection of the superior vena cava and reconstruction with expanded-PTFE graft

Abstract

A case of primary mediastinal germ cell tumor, which was radically treated with reconstruction of the superior vena cava (SVC) after neoadjuvant chemotherapy, is reported herein. This tumor, accompanied with SVC syndrome, was initially unresectably advanced and chemotherapy, using cis-dichlorodiamine-platinum, vindesine and bleomycin, was administered, resulting in a partial response with a 65 per cent tumor regression. The serum human chorionic gonadotropin, which originally had a high value, became reduced in parallel with the tumor regression to within the normal range. Complete tumor resection with reconstruction of the SVC using an expanded polytetrafluoroethylene (EPTFE) graft was successfully performed. The patient has now returned to productive employment and the graft is patent without any clinical symptoms of recurrence, 15 months post-operatively. Neoadjuvant chemotherapy is considered to be vitally important for the treatment of germ cell tumors originating in the anterior mediastinum and an EPTFE graft with external ring support seems to be acceptable as an artificial substitute for SVC replacement.