Case Report: Primary Embryonal Carcinoma of the Anterior Mediastinum

Abstract

The anterior mediastinum is the most common extragonadal location for germ cell tumors and accounts for about 50% to 70% of such neoplasms. Embryonal cell carcinomas are one of the rarest forms and account for less than 2%. We present the case of a 19-year-old male who was found to have a primary embryonal cell carcinoma of the anterior mediastinum. This case illustrates the subtle complaints that these patients present with, some of the problems and decisions that go into making the diagnosis, and the response to the appropriate therapy. The following discussion takes a look at the variety of germ cell tumors, the vast differential of an anterior mediastinal mass, the workup of such a mass, and the various treatments and outcomes of extragonadal germ cell tumors I. Case Report: 19-year-old man presented with shortness of breath. He had been losing weight for several months. A chest radiograph revealed a large anterior mediastinal mass . A CT scan showed that the mass extended in the anterior mediastinum from the manubrium to the diaphragm.The mass was heterogeneous but solid, encasing and displacing the great vessels and narrowing the main bronchi, especially on the right . Echocardiography showed a large pericardial effusion with cardiac tamponade. Peri-cardiocentesis and drainage were performed. After the patient's condition had stabilized, an open biopsy of the mediastinal mass was performed. Microscopy showed a solid neoplasm with a glandular architecture,consisting of highly atypical cells with a moderate amount of eosinophilic cytoplasm and large, round nuclei with prominent nudeoli. The final pathologic diagnosis was embryonal carcinoma, primary to the anterior mediastinum.