Mediastinal germ cell tumors (surgery).

Abstract

F ROM 1966 TO 1976, 472 patients with metastatic germ cell tumors from primary tumors in the testes were seen at Memorial Hospital, i.e., approximately 47 patients per year. From 1949 to 1971, 30 germ cell tumor patients with the primary tumor in the mediastinum were seen at Memorial Hospital, i.e., approximately 1.4 patients per year. From this data, it can be seen that most germ cell tumors in the chest occur as metastases from germ cell tumors in the testes (47 to 1.4), or about 33 times more frequently. However, an occasional primary germ cell tumor in the mediastinum confronts the medical and surgical oncologist. A detailed description of our best known patient with a primary germ cell tumor in the mediastinum follows. On November 24, 1969, a 26-yr-old Chicago Bears football player, Brian Piccolo, entered Memorial Hospital for the first time. A mediastinal tumor had been found by chest x-ray and it had been biopsied by thoracotomy on I l/20/69 in Chicago. The pathologic diagnosis was felt to be embryonal cell carcinoma in a teratoma. After admission to Memorial Hospital, studies revealed no disease outside the chest and that the testes were perfectly normal. He received 2.5 mg of actinomycin intravenously on 1 l/26/69 and was taken to the operating room on 1 l/28/69. Through a sternal splitting incision with extension of the left anterior thoracotomy, a large anterior mediastinal tumor was removed along with a portion of the pericardium. It was adherent to the lung in the area of previous biopsy so that it was necessary to wedge excise the upper part of the lingula and lower part of the anterior segment of the left upper lobe. There was one lymph node in the anterior superior mediastinum that was positive for embryonal cell carcinoma. The tumor was seemingly completely removed. The pathologic report of the specimen was that this was a malignant mediastinal teratoma growing predominantly as embryonal cell carcinoma. However, there were additionally areas of sarcoma, seminoma, squamous carcinoma, and a focus suggesting choriocarcinoma. He was discharged home on 12/l O/69 to continue receiving chemotherapy. He was treated with actinomycin for 1 mo.