Abstract
BackgroundPrimary malignant mediastinal germ cell tumor (PMMGCT) is rare and sometimes the prognosis of the patients with PMMGCT is not very satisfactory.MethodsA total of 54 patients with PMMGCT in a follow-up from 1990 to 2009. We evaluated the role of the surgical treatment and the effect of multimodality treatment strategy for patients with PMMGCT.ResultsFifty-two patients underwent surgical resections, while the other two patients just received chemoradiotherapy. Among the 52 patients, 28 cases received preoperative adjuvant therapy and 24 cases underwent surgery as initial treatment; 30 cases with complete resections, 18 cases with partial resections and 4 cases with only biopsies. There was no perioperative mortality. Histopathologic results revealed 18 cases of seminomas and 36 cases of nonseminomatous germ cell tumors (NSGCT). The last follow-up showed that 17 patients were alive, including 11 patients with seminoma and 6 patients with NSGCT. The 5-year overall survival rate of patients with seminomas was 87.7%. The 3-year and 5-year overall survival rates of patients with NSGCT were 47.4% and 23.0%, respectively.ConclusionsIt could be concluded that a complete surgical resection of PMMGCT after chemoradiotherapy showed favorable long-term survival. Patients with pure seminomas have a better prognosis compared with that with NSGCT.Virtual slidesThe virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1676987232116837.
Highlights
Primary extragonadal germ cell tumors (GCT) are rare and account for only 1% to 5% of all germ cell malignancies [1,2]
Controversy still exists regarding the effectiveness between surgical resection and chemotherapy, but multidimensional treatment has become the standard treatment for mediastinal nonseminomatous germ cell tumors (NSGCT)
Among 52 patients treated with surgery, 22 patients received cisplatin-based chemotherapy as basic treatment on the basis of a serologic diagnosis or the needle biopsy followed by surgical resection; 6 patients received preoperative radiotherapy, which was not very effective, followed surgical resection thereafter; 24 patients underwent surgery as basic treatment (Table 2)
Summary
Primary extragonadal germ cell tumors (GCT) are rare and account for only 1% to 5% of all germ cell malignancies [1,2]. The most common extragonadal sites are the mediastinum and retroperitoneum [3] These extragonadal germ cell tumors histologically contain the same components as their gonadal counterparts, but may have different biologic behaviors, clinical characteristics and inferior overall prognoses [4]. Primary malignant mediastinal germ cell tumors (PMMGCT) are rather rare and represent only 1% to 4% of all mediastinal tumors [5]. Surgical resection of the residual mass after chemotherapy plays an important role in controlling mediastinal NSGCT. This multimdimensional treatment strategy serves to assess response, to remove chemotherapy-resistant disease, and to guide additional chemotherapy. Primary malignant mediastinal germ cell tumor (PMMGCT) is rare and sometimes the prognosis of the patients with PMMGCT is not very satisfactory
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