Abstract
Mediastinal germ cell tumors are rare malignant tumors whose current management strategy involves making a prompt diagnosis and providing an appropriate chemotherapy. However, there is as yet no consensus regarding the optimal management postchemotherapy. We encountered the case of a 23-year-old man who was diagnosed as having a mediastinal nonseminomatous germ cell tumor. We evaluated its response to induction chemotherapy by fluorodeoxyglucose-positron emission tomography/computed tomography. We performed complete surgical excision of the residual tumor postchemotherapy. Histopathologic examination of the surgical specimen showed no viable tumor cells.
Highlights
IntroductionA malignant mediastinal germ cell tumor (GCTs) is rare and represents only 1% to 4% of all mediastinal tumors
We report a case of mediastinal nonseminomatous yolk sac tumor showing a decreasing FDG uptake postchemotherapy, with no viable tumor cells histopathologically upon resection of the surgical specimen
The tumor remained in the left thorax, the tumor diameter decreased to 26 mm on chest computed tomography (CT) (Figure 1C), the FDG uptake decreased with an SUV max of 2.5 on fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT (Figure 1D), and the serum alpha fetoprotein (AFP) level normalized after the combination chemotherapy
Summary
A malignant mediastinal germ cell tumor (GCTs) is rare and represents only 1% to 4% of all mediastinal tumors. Induction cisplatin-based chemotherapy followed by surgery has been shown to improve the survival outcome of mediastinal nonseminomatous GCT [4]. We report a case of mediastinal nonseminomatous yolk sac tumor showing a decreasing FDG uptake postchemotherapy, with no viable tumor cells histopathologically upon resection of the surgical specimen. FDG-PET/CT revealed an anterior mediastinal tumor with high FDG accumulation with a standardized uptake value max (SUVmax) of 9.9 (Figure 1B), with no other abnormal FDG uptake, including the testes. The tumor remained in the left thorax, the tumor diameter decreased to 26 mm on chest CT (Figure 1C), the FDG uptake decreased with an SUV max of 2.5 on FDG-PET/CT (Figure 1D), and the serum AFP level normalized after the combination chemotherapy. The residual tumor was resected completely and showed no viable tumor cells pathologically (Figure 2a-2C). Tumor recurrence has not been detected for more than 12 months postoperatively without adjuvant chemotherapy
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