Extragonadal Germ Cell Tumors Research Articles

Could Aberrant Migration Explain Metachronous Germ Cell Tumors?

Background Extragonadal germ cell tumors (GCTs) are thought to arise as a result of local transformation of primordial gonadal cells (PGCs) that become misplaced during embryogenesis. With the exception of bilateral testis tumors, metachronous GCT (i.e., occurring at a site classically described for primary GCTs) are rare events. Patients and Methods The clinical, radiological, and molecular data (if available) of patients with metachronous GCT were analyzed. Results Three Caucasian males were identified: case 1 presented with a pineal germinoma 19 years after a mediastinal seminoma that had been treated with chemotherapy, case 2 presented with a pineal non-seminomatous GCT (NSGCT) that occurred three years after a mediastinal seminoma treated with chemotherapy, and case 3 presented with a mediastinal seminoma concomitant with a suprasellar germinoma that occurred two years after a stage I testicular NSGCT treated exclusively with surgery. None of these patients had a positive family history or disorder of sex development. Molecular data were available for cases 2 and 3. In case 2, a CHEK2 gene biallelic inactivation in the second tumor suggested chemoresistance to cisplatin. This was further confirmed by tumor progression during second-line treatment. In case 3, the molecular analysis revealed different profiles in the three tumors, thus suggesting distinct tumor cell origins. Conclusion These rare cases should alert clinicians of the possibility of multiple GCTs that should not be considered to be relapses. The underlying physiopathology is unknown, but multiple PGC mismigrations is a likely cause. Initial treatment with cisplatin may select chemo-resistant clones, thereby making the subsequent treatment more of a challenge.

Malignant recurrence after mature Sacrococcygeal teratoma: A meta-analysis and review of the literature.

Sacrococcygeal teratoma (SCT) is a rare extragonadal germ cell tumour mostly diagnosed during infancy and early childhood. Neonatal SCTs are mostly mature, but can also contain immature and/or malignant components. Recurrence of an SCT alters prognosis, especially when it is malignant, of which its mechanism is not yet fully understood. This study is a review and meta-analysis of the literature on malignant recurrences after an initially mature SCT. A literature search was performed to identify studies describing children with SCT and presenting specific information on histology of the initial tumour as well as the recurrence. Random effect models for mature recurrence and malignant recurrence after an initially mature SCT were employed to pool study-specific percentages in order to estimate an overall percentage and its associated 95 % confidence intervals (CI). Inverse variance method, which gives more weight to larger studies, was used to pool outcomes for the different studies. A total of 22 articles, comprising 1516 patients with SCT, were included in the meta-analysis. The pooled proportions of mature and malignant recurrences after mature SCT were 3 % (95 % CI 1-4 %) and 5% (95 % CI 3-6 %), respectively. Fifty-seven (56 %) of a total of 102 recurrences after resection of an initially mature SCT were malignant, mostly yolk sac tumour (YST). Many recurrences occurred within 1-6 years, however some occurred as long as 20 years after initial diagnosis. A substantial number of recurrences of mature SCT present as a malignant tumour. Overlooking malignant components on initial pathological evaluation and the progression of mature SCT cells to malignant cells may play a role. Treatment of mature SCTs with resection alone requires thorough follow-up of at least 6 years. Future research is needed to determine whether SCTs with malignant microfoci should be treated or followed-up differently from mature or immature SCTs. In addition, the value of serum biomarkers in follow-up after SCT needs to be further evaluated.

MIXED GERM CELL TUMOR PRESENTING AS LARGE MEDIASTINAL MASS

SESSION TITLE: Fellows Disorders of the Mediastinum Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Extragonadal Germ cell tumors involving the mediastinum are rare and accounts for 3-4% of all germ cell tumors1.Literature review showed only small number of case reports about mixed germ cell tumors involving mediastinum or lungs. We present a rare case of young female presented with very large mediastinal mass. CASE PRESENTATION: 27-year-old female with no significant past medical history presented to the emergency room for the complaint of left-sided chest. She states she has been having intermittent chest pain for the last 2 months with pain radiates to left upper back, describes pain as sharp and stabbing in nature, gets worse with breathing movement and progressively getting worse. She also had night sweats and productive cough but denied any fevers, chills, weight loss, hemoptysis. Patient is never smoker and denied any second hand smoke exposure. Blood work-up was unremarkable, EKG showed sinus tachycardia. Chest x-ray showed left hemithorax opacification concerning for mass, she had CT chest done which showed massive left hilar mass. Patient underwent CT-guided biopsy which showed possible teratoma versus pulmonary hamartoma. Cardiothoracic surgery was consulted and patient underwent left thoracotomy with excision of left-sided intrathoracic mass. Pathology results consistent with mixed germ cell tumor comprised of teratoma with yolk sac tumor. Patient did well after surgery and discharged home with oncology follow-up. DISCUSSION: The differential diagnosis of mediastinal tumors is challenging and includes thymomas, esophageal/thyroid cancers, lymphomas, bronchogenic cysts and extra gonadal germ cell tumors. Germ cell tumors include Teratoma (mature and immature), Yolk sac tumor, Seminoma, Choriocarcinoma, Embryonal carcinoma and Mixed germ cell tumors. Germ cell tumors account for 20% of mediastinal tumors with teratoma and seminomas being most common cause. Because of multiple components of tumor, sampling of mediastinal germ cell tumors can be misleading. In one case report the germ cell tumor was misdiagnosed as hemangioma and in other case report, biopsy led to life threatening bleeding resulting in death of patient. Presenting symptoms include chest pains, shortness of breath, hemoptysis, and trichoptysis (expectoration of hair).Treatment options include complete surgical resection and chemotherapy. Complete resection is important as survival rate is low for patients with residual tumors. Mixed germ cell tumors with malignant components are more aggressive with survival rate less than 2 years. CONCLUSIONS: Extra gonadal Germ cell tumor involving mediastinum are rare, physicians need to be aware of difficulties and complications associated with diagnosis. Germ cell tumors should be considered in differential diagnosis of mediastinal mass especially in young patients. Reference #1: Moreira AL, Ströbel P, Chan JKC et al. Germ cell tumours of the mediastinum. Seminoma. In: WHO Classification of Tumours of Lung, Pleura, Thymus and Heart, 4th edn. IARC, Lyon 2015; 244–8. Reference #2: Sakane T, Okuda K, Murase T, Watanabe T, Oda R, Tatematsu T, Yokota K, Haneda H, Inagaki H, Nakanishi R. Mixed-type primary germ cell tumor of the mediastinum in a young adult male with a sudden life threatening condition: A case report. Thorac Cancer. 2020 Jan;11(1):166-169. doi: 10.1111/1759-7714.13231. Epub 2019 Nov 6.PMID: 31693305 DISCLOSURES: No relevant relationships by Imran Amer, source=Web Response No relevant relationships by Adnan Khan, source=Web Response No relevant relationships by Sana Khan, source=Web Response No relevant relationships by Thomas Maloney, source=Web Response No relevant relationships by Moeez Qureshi, source=Web Response

PRIMARY MEDIASTINAL SEMINOMA FOUND ON EVALUATION FOR WEIGHT LOSS

SESSION TITLE: Medical Student/Resident Disorders of the Mediastinum Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Extragonadal germ cell tumors (GCTs) typically arise in midline locations such as mediastinum and retroperitoneum. They are formed either due to failure of primordial germ cells to migrate to the gonadal ridges [1] or reverse migration of the transformed germ cells in the testes [2]. Mediastinal seminomas are rare tumors constituting about 1/3rd of malignant mediastinal GCTs and 2-4 percent of mediastinal masses [3]. CASE PRESENTATION: A 55-year-old man with a history of active smoking (½ pack cigarettes per day), hepatitis C, bipolar disorder, prior alcohol/intravenous drug use (heroin and cocaine) presented with shortness of breath and 50-pound weight loss. Chest computed tomography (CT) revealed a 3.0 x 1.1 cm para-aortic lymph node. Positron emission tomography (PET/CT) scan showed hypermetabolic activity (maximum standardized uptake value of 10). Bronchoscopy with EBUS (endoscopic ultrasound) and mediastinoscopy were considered as methods to obtain tissue but discarded due to the location of the mass. He underwent a left Video-assisted thoracoscopic surgery (VATS) which showed seminoma. H&E (hematoxylin and eosin) slides revealed pale tumor cells with distinct nuclei and prominent central nucleoli in a background of lymphocytic infiltrate. The tumor cells stained positive for germ cell markers CD117, Oct 3/4 and Sall 4; but were negative for melanoma markers (Mart1a, S100), as well as CK20, CK7, Pancytokeratin, CD30, CD15, TTF1 and CDX2. DISCUSSION: Mediastinal seminomas occur mainly in men aged 20 to 40 years. They are typically slow growing and can be very bulky by the time they cause symptoms. Serum beta subunit of human chorionic gonadotropin (beta-hCG) is elevated in approximately one-third of patients. They do not produce alpha-fetoprotein (AFP). Ultrasound is advised in all cases to evaluate for any testicular primary. Seminomas are exquisitely sensitive to both cisplatin-based chemotherapy and radiotherapy (RT) but local control with surgery and RT only have modest success due to their typically later presentation. The commonly used chemotherapy regimens are 3 cycles of bleomycin/etoposide/cisplatin (BEP) or 4 cycles of etoposide/cisplatin (EP) (in patients who have previously received RT, who have underlying lung disease or age more than 50 years to avoid bleomycin lung toxicity). Long-term disease-free survival is achieved in roughly 90 percent of patients treated with chemotherapy. CONCLUSIONS: Primary mediastinal seminoma is a malignant extragonadal GCT most commonly found in the anterior mediastinum. Usually, young men in their 20-40s present with large 4-11cm anterior mediastinal masses which cause symptoms by compressing local structures. Or, as in our case, they are found incidentally. Surgery/RT can be considered but many patients present late so local control is not possible. However, these tumors respond well to chemotherapy with complete response rates of 90% Reference #1: Intracranial germ cell tumors: a comprehensive review of proposed embryologic derivation; Glenn OA, Barkovich AJ; Pediatr Neurosurg. 1996;24(5):242; PMID 8933567 Reference #2: Genetics and biology of adult human male germ cell tumors; Chaganti RS, Houldsworth J; Cancer Res. 2000;60(6):1475; PMID 10749107 Reference #3: Primary germ cell tumors of the mediastinum: II. Mediastinal seminomas--a clinicopathologic and immunohistochemical study of 120 cases; Moran CA, Suster S, Przygodzki RM, Koss MN; Cancer. 1997;80(4):691; PMID 9264352 DISCLOSURES: No relevant relationships by William Han, source=Web Response No relevant relationships by Sahib Singh, source=Web Response

An extragonadal germ cell tumor with dermatomyositis: A case report and literature review.

The risk of malignancy in inflammatory myopathy patients is well recognized. However, the incidence of germ cell tumor (GCT) with inflammatory myopathy is low, and most reported cases of GCT also exhibit testicular tumors. Therefore, a case of extragonadal GCT with dermatomyositis (DM) is reported in the current study to better understand this paraneoplastic syndrome. A 53-year-old man presented with bilateral cervical lymph node enlargement. A lymph node biopsy showed embryonal carcinoma, and computed tomography showed multiple lymph node and lung metastases. A period of one month after bleomycin, etoposide and cisplatin (BEP) chemotherapy, this patient developed an erythematous eruption over the extensor surfaces of bilateral fingers, or Gottron's sign and facial erythema. The patient was diagnosed with DM with a positive anti-TIF-1γ-antibody result. High-dose prednisolone was effective, and there has been no evidence of cancer recurrence for over one year. The literature review identified 17 cases of GCT with inflammatory myopathy that have been reported so far, and it was indicated that this is the first case of extragonadal GCT with DM following chemotherapy. This case highlights the importance of monitoring after the completion of cancer treatment, as distinctive dermal and muscular symptoms should cause us to consider the possibility of paraneoplastic inflammatory myopathy.

Abstract 5169: Tissue analysis of NAD(P)H: quinone oxidoreductase (NQO1) and catalase expression in patients with germ cell tumors (GCT)

Abstract Background: Testicular germ cell tumor (GCT) is the most common cancer in young men between 15 and 35 years of age. Cisplatin-based combination chemotherapy will cure 70% of patients with metastatic GCT. Patients who relapse can still be cured with salvage standard-dose or high-dose chemotherapy. However, about 15% of patients with relapsed/refractory GCT are incurable. NAD(P)H:quinone oxidoreductase 1 (NQO1) is a two-electron oxidoreductase elevated in several tumor types compared to normal tissue. NQO1 detoxifies quinones and reduces oxidative stress. NQO1 bioactivatable drugs induce DNA damage in cells overexpressing NQO1, but not in cells lacking it, hence delivering tumor-selective damage and cell death. Alterations in catalase expression can cause cytoprotection. The ratio of NQO1:catalase activities is presumed to be a predictive marker for therapeutic activity of NQO1 bioactivatable drugs. There is no existing data on NQO1 or catalase expression in GCTs. Methods: Patients with testicular or extra-gonadal GCT who had surgery between January 2016 and December 2018 were identified from the Indiana University Melvin and Bren Simon Cancer Center Tissue Bank database. Patients with non-seminomatous GCT (NSGCT) of testis or primary mediastinal NSGCT were selected and specimens obtained. Immunohistochemistry staining was performed on tumor tissue to determine the quantity and intensity of NQO1 and catalase expression. Results: NQO1 and catalase expression were determined in 16 patients. Thirteen specimens stained moderately to strongly positive for NQO1. Only 1 specimen stained negative. Conversely, no specimen stained strongly positive for catalase, and only 2 stained moderately positive. Fourteen specimens were catalase deficient or only mildly positive for catalase. The details of the immunostaining is summarized in the table below. Immunohistochemistry staining for NQO1 and catalase in GCTImmunostainNegative(0)Mildly positive (<10%)Moderately positive (10-50%)Strongly positive (>50%)NQO1Quantity01114Intensity0547Combined score1267CatalaseQuantity3472Intensity31120Combined score7720 Conclusions: NSGCTs appear to have high levels of NQO1 and deficiency of catalase. NQO1 bioactivatable agents could serve as a potential therapeutic approach in patients with refractory testicular GCTs. Citation Format: Neda Hashemi Sadraei, Nabil Adra, Constance Temm, Kenneth A. Kesler, Muhammad T. Idrees, David A. Boothman, Lawrence Einhorn. Tissue analysis of NAD(P)H: quinone oxidoreductase (NQO1) and catalase expression in patients with germ cell tumors (GCT) [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5169.

Mediastinal teratoma presenting as a cervical tumor: images.

Benign extra-gonadal germ cell tumors, known as teratoma or dermoid cysts, are commonly found in the anterior mediastinum in association with the thymic gland. This association is due to their common site of embryological origins, from the third and the fourth pharyngeal pouches. Since it is not unusual to find normal thymic tissue in the neck, germ cell tumors arising from here will present as a cervical tumor. We submit the typical images of one such tumor in a young adult. Intraoperatively, the tumor was well encapsulated and was connected to the mediastinal thymus by a long pedicle of thymic tissue. It was not related to the thyroid gland unlike a primary cervical teratoma. We present these typical images of a mediastinal dermoid in this unusual cervical location. The differential diagnoses to be considered clinically are primary cervical teratomas, thyroid tumors, lymph nodal pathologies, and branchial cyst.

Autologous stem cell transplantation in patients with extragonadal germ cell tumors: A single center experience

Autologous stem cell transplantation in patients with extragonadal germ cell tumors: A single center experience

SUN-499 Extragonadal Germ Cell Tumor Induced Thyrotoxicosis

Background: Extragonadal Germ Cell Tumors (EGCTs) are extremely rare, with an incidence of around 1/1,000,000 and highly variable prognosis dependent on subclassification as seminomatous or non-seminomatous. Non-seminomatous germ cell tumors can cause significant enough elevations in hCG to induce thyrotoxicosis via structural homology allowing for cross-reactivity with the TSH-receptor. Limited cases involving EGCTs inducing thyrotoxicosis have been studied. Case: A 27-year-old male presented to the emergency department with intractable abdominal and back pain. He reported night sweats, nausea, dizziness, and a 10 lb weight loss in 1 week. He was resting comfortably and only complaining of pain. He was moderately tachycardic, tachypneic and hypertensive, with a physical exam only remarkable for tenderness to palpation of the abdomen. Abdominal CT revealed mesenteric and retroperitoneal lymphadenopathy, bilateral adrenal enlargement, a mass in the head of the pancreas, as well as gallbladder and common bile duct distention. Lymph node biopsy was conducted for a suspected lymphoma; however, pathology found a poorly differentiated carcinoma. A diagnosis of a non-seminomatous EGCT was made when ultrasound of the testes was negative for masses and labs revealed elevations in hCG (74842 mIU/ml), and LDH (1421 U/L) with normal AFP (6.98 ng/mL). Further workup showed a slightly elevated T4 Free Thyroxine (1.55 ng/dl) with normal TSH (0.555 mIU/L); thus his thyrotoxicosis was secondary to the high HCG. Treatment for thyrotoxicosis was deferred with the expectation that symptoms would resolve when the tumor burden was decreased. Our patient had numerous other complications requiring management from nephrology, GI and urology teams in addition to endocrinology and hematology-oncology. Bleomycin, Etoposide and Cisplatin (BEP) combination chemotherapy was initiated after recovery from acute complications. Further pathology evaluation suggested tumor susceptibility to the biologics nivolumab and pembrolizumab. Conclusion: Patients with thyrotoxicosis secondary to metastatic non-seminomatous germ cell tumors often present with widespread metastasis and relatively few symptoms of thyrotoxicosis that resolve as the hCG levels decrease with chemotherapy without specific antithyroid medication. This case highlights the importance of considering clinically occult thyrotoxicosis in patients who have elevated hCG secondary to germ cell tumors. Early detection of germ cell tumor and recurrence is crucial for chemotherapeutic success. Thus, patients should be closely followed for thyrotoxicosis relapse which could potentially herald a carcinoma relapse and aid in early diagnosis.

Primary Extragonadal Germ Cell Tumors in Klinefelter Syndrome: 10-Years of Experience from a Single Institute

Primary Extragonadal Germ Cell Tumors in Klinefelter Syndrome: 10-Years of Experience from a Single Institute

Case Report Mediastinal Teratoma Resembling Vascular Tumor with Rapid Growth Accompanied by Vena Cava Superior Syndrome and Bilateral Paramalignant Pleural Effusion

Background: Teratomas are tumors originate from germ cells, consist of well differentiated tissue from more than one of three layers of embryonic cells: ectoderm, mesoderm and endoderm. Teratomas are generally slow-growing and asymptomatic. Mediastinal teratoma is the most common extra-gonadal germ cell tumor. Superior vena cava syndrome and bilateral paramaligant pleural effusion are complications which can occur in mediastinal teratomas. Case: We report a 37-year-old woman presented with shortness of breath since 1 month before admission, chest pain, cough, weight loss, swolen of face, neck, and right arm. Chest x-ray showed mediastinal tumor. However, no mediastinal tumor had been detected by chest x-ray to examine her heart disease 3 years earlier. Chest computed tomography scan showed anterosuperior mediastinal tumor surrounding great blood vessels and bilateral pleural effusion. Computed tomography guided transthoracic fine needle aspiration biopsy revealed tumor containing mature squamous epithelial component. Patient underwent open biopsy by sternotomy and histological assessment confirmed the diagnosis as mediastinal teratoma with vascular lesions predominantly resembling vascular tumor.Conclusion: Establishing the diagnosis of mediastinal teratoma is challenging and it requires multi modality approaches.  Keywords: Mediastinal teratoma, vena cava superior syndrome, bilateral paramalignant pleural effusion.

The Role of Surgical Resection as A Salvage Therapy and Immunohistochemical Stain to Confirm Mediastinal Yolk Sac Tumor

Background: Mediastinal germ cell tumors are uncommon, representing less than 1% of all malignancies. They mostly occur in young men after puberty and have a poor prognosis with over all long term survival rate 42%. Case Report: We reported a case report in Saiful Anwar Malang Hospital, Indonesia, a young man, 26 years old with an anterior mediastinum tumor and VCSS The CT scan of the chest showed an anterosuperior mediastinal mass which compress the superior vena cava. The result from transthoracic FNAB with USG guidance showed an extragonadal germ cell tumor which resemble an Embryonal Carcinoma from mediastinum. The AFP serum level was elevated. Patient underwent a radiotherapy and a surgical debulking. The biopsy showed an Endodermal Sinus Tumor (Yolk Sac). Immunohistochemical stain for cytokeratin was positive in the tumor cells while stain for CD30 was negative. These were confirming the diagnosis of primary mediastinal yolk sac tumor. Patient received a combination chemotherapy for a total 6 cycles.Conclusion: Some procedures like biopsy, tumor marker, immunohistochemical stain, could differentiate the subtype of mediastinal germ cell tumor. The multimodality treatment by combining chemotherapy with surgical therapy or radiotherapy could increase the survival outcome of patients.

Managing extragonadal germ cell tumors in male adults

Managing extragonadal germ cell tumors in male adults

Effect of prophylactic anticoagulation on incidence of venous thromboembolism in testicular germ cell tumor patients.

422 Background: Testicular germ cell tumors (GCTs) are among the most common solid tumors in young males. With the availability of highly effective treatment, improving patients’ quality of life has gained more focus in recent years. Venous thromboembolism (VTE), commonly occurring in GCT patients, is associated with increased morbidity and mortality. Prophylactic anticoagulation has been shown to decrease the risk of VTE in cancer patients. In this retrospective study we evaluated the effect of low molecular weight heparin (LMWH) prophylaxis during hospitalization on incidence of VTE and outcome in GCT patients treated with first-line chemotherapy. Methods: Study population included 394 chemotherapy-naive GCT patients treated with first-line chemotherapy at the National Cancer Institute, Bratislava, Slovakia from January 2000 to December 2017. VTE was defined as any venous thrombosis or pulmonary embolism, confirmed by imaging, occurring during first-line chemotherapy. No visceral thromboses were observed. Results: Forty-one out of 394 patients (10.4%) were diagnosed with VTE on initial staging and were excluded from the analysis. Final cohort included 353 patients. LMWH prophylaxis was administered to 104 patients (29.5%), 249 patients (70.5%) did not receive prophylaxis. We observed 14 (4.0%) VTE events. The difference in VTE incidence between patients with and without prophylaxis was not statistically significant (5.8% vs. 3.2% p = 0.37). We have observed a trend to longer overall survival in patients without prophylaxis (HR = 0.61, 95%CI = 0.32-1.13, p = 0.08). Patients with extragonadal GCT receiving VTE prophylaxis had significantly shorter survival compared to patients without prophylaxis (HR = 0.29, 95%CI = 0.08-1.12, p = 0.04). Conclusions: LMWH prophylaxis was not associated with decreased VTE incidence. Moreover, it was associated with shorter survival in extragonadal GCTs. Taking into account these data, LMWH prophylaxis during hospitalization should not be used in GCT patients receiving chemotherapy.

Metachronous testicular tumour recurrence in extra-gonadal germ cell tumour: A case report and review of the literature

A 24-year-old male presented in 2014 with left sided abdominal pain and a palpable abdominal mass. After appropriate investigation a diagnosis of an extra-gonadal germ cell tumour was made and he was treated with platinum based chemotherapy. He then underwent retroperitoneal lymph node dissection due to residual disease identified on imaging with no specific tissue type identified on the histological sample. In early 2019 he presented to his General Practitioner with a left sided testicular lump and was diagnosed with non-seminomatous germ cell tumour of the testis, an uncommon condition; metachronous testicular tumour. Level of Evidence: 5

HCG-secreting malignancies – diagnostic pitfalls

We present a case of a 34-year-old male patient referred to our Uro-oncology Department with a suspicion of a metastatic germ cell tumour, owing to enlarged left testicle and elevated b-hCG concentration (39 mIU/mL). Impaired performance status caused by extensive pulmonary and liver metastases, accompanied by significant lymphadenopathy, necessitated prompt management. However, a testicular tumour was excluded on ultrasound imaging; a hydrocele only was found. The b-hCG concentration was not increasing (37 mIU/mL). We found a diagnosis of an extragonadal germ cell tumour doubtful, and a liver biopsy was performed. Due to the patient’s quick deterioration, we decided to commence pre-phase chemotherapy with cisplatin and etoposide, which resulted in a significant clinical improvement. The pathological examination, along with immunoassays, revealed undifferentiated cholangiocarcinoma, and the patient continued chemotherapy with a biliary tract cancer regimen, i.e. cisplatin and gemcitabine. Unfortunately, the clinical response was short-lived; the disease progressed, the patient was offered best supportive care and died two months after the diagnosis. The case underpins the literature review with respect to differential diagnosis of an elevated hCG concentration. In particular, we discuss ectopic secretion in non-trophoblastic and non-germinal malignancies and the causes of false positive assays.

Systemic therapy for primary and extragonadal germ cell tumors: prognosis and nuances of treatment.

Testicular germ cell tumors are the most common solid tumors in young men. These cancers represent a success story of modern medicine in our ability to cure young patients and offer decades of life, with a 5-year survival rate of approximately 95%. This review outlines the staging and risk classification of testicular cancers, and reviews the current state of knowledge and standard of care for the systemic treatment of testicular germ cell tumors with chemotherapy, focusing on the relevant clinical data supporting each treatment regimen. This review also briefly highlights current areas of active investigation, notably in the relapsed and refractory setting, including ongoing clinical trials.

Extragonadal germ-cell tumors – a review of the pathogenesis, histopathological findings, diagnosis and treatment

Extragonadal germ-cell tumors – a review of the pathogenesis, histopathological findings, diagnosis and treatment

Germ cell tumors in male patients without gonadal involvement: computed tomography/magnetic resonance imaging findings and diagnostic workflow.

Extragonadal germ cell tumors (EGCTs) represent 1% to 5% of all germ cell tumors (GCTs) (1). Morphological type includes mature/immature teratoma, seminoma, yolk sac tumor, embryonal carcinoma, choriocarcinoma and mixed gonadal GCTs.

Mediastinal mature teratoma in an adolescent: a rare case presentation

Teratomas are the most common germ cell tumours composed of two or more germ layers. Mediastinum is the most common site of extragonadal germ cell tumour. Teratomas are relatively rare of all tumours in mediastinum. Here, we report a rare case of an adolescent who presented with chest pain and breathlessness. CT scan showed a large, well-defined lesion with internal fat density, calcifications, cystic and solid components arising from anterior mediastinum. He was successfully operated and treated at New Civil Hospital Surat attached to Government Medical College Surat. The purpose of this case report is to bring in light to the mediastinal mature teratomas in adolescents as they have very low incidence rate.