Abstract
We present a case of 16-year-old male, who was referred from private centre for dyspnoea, fatigue, and orthopnea. The chest radiograph revealed complete opacification of left chest which was confirmed by computed tomography as a large left mediastinal mass measuring 14 × 15 × 18 cm. The diagnostic needle core biopsy revealed mixed germ cell tumour with possible combination of embryonal carcinoma, yolk sac, and teratoma. After 4 cycles of neoadjuvant BEP regime, there was initial response of tumour markers but not tumour bulk. Instead of classic median sternotomy or clamshell incision, posterolateral approach with piecemeal manner was chosen. Histology confirmed mixed germ cell tumour with residual teratomatous component without yolk sac or embryonal carcinoma component. Weighing 3.5 kg, it is one of the largest mediastinal germ cell tumours ever reported. We describe this rare and gigantic intrathoracic tumour and discuss the spectrum of surgical approach and treatment of this exceptional tumour.
Highlights
Germ cell tumours are embryologically derived from reproductive cells, and they originate mostly from the gonads
A huge intrathoracic mass may compress the contralateral lung during positioning which may obstruct the venous return to the heart and poses a challenge to the attending anaesthetist
Computed tomography (CT)-guided biopsy was performed which was suggestive of mixed germ cell tumour with possible combination of embryonal carcinoma, yolk sac, and teratoma
Summary
Germ cell tumours are embryologically derived from reproductive cells, and they originate mostly from the gonads. In 5% of the cases, they are extragonadal in origin [1]. Huge intrathoracic mass poses a dramatic challenge for operating surgeons and anaesthetists in terms of the management strategies. According to a surgeon’s point of view, the nature of mass suggests the possible surgical difficulties with regard to the approach and accessibility. A huge intrathoracic mass may compress the contralateral lung during positioning which may obstruct the venous return to the heart and poses a challenge to the attending anaesthetist. We present a case of gigantic intrathoracic germ cell tumour which was resected successfully via a piecemeal surgical approach. The anatomical basis of this huge tumour and the treatment modalities are discussed
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