A. De Backer G.C. Madern F.G.A.J. Hakvdort-Cammel Mediastinal germ cell tumors: clinical aspects and outcomes in seven children Eur J Pediatr Surg 16 5 2006 (October) 318 322

Abstract

Mediastinal germ cell tumors presenting during childhood are exceedingly rare, and publications on the entity being very scarce. This article reports on clinical presentation, methods of treatment, complications, results, and outcomes in 7 children with mediastinal germ cell tumors. Median age of the 4 boys and 3 girls was 3 years (range, 21 months-15 years). The most frequent symptoms were respiratory distress, persistent coughing, thoracic pain, and anorexia/weight loss. Four patients had histologically benign tumors (mature teratoma). Their sole treatment consisted of complete surgical excision of the tumor and (part of) the thymus using either median sternotomy or left-sided thoracotomy. Recovery was uneventful. Malignant tumors were found in 3 patients (1 yolk sac tumor, 1 chorid carcinoma, 1 malignant toratoma). Treatment consisted of either biopsy or debulking after chemotherapy and radiotherapy (1 case). Two of them died because of uncontrollable metastatic disease, whereas the patient with yolk sac tumor is in remission 4 years after diagnosis. Both this study and review of the literature testify to the extreme rarity of mediastinal germ cell tumors in childhood. Children with this type of tumor are usually extremely symptomatic. Histologically benign tumors have an excellent prognosis, provided that surgical excision is complete. The use of platinum-based combination chemotherapy has considerably improved the prognosis in malignant tumors.