Mediastinal Mixed Germ Cell Tumor Research Articles

PRIMARY MEDIASTINAL CHORIOCARCINOMA (PMC) IN A YOUNG WOMAN WITH HEMOPTYSIS AND A LUNG MASS

SESSION TITLE: Medical Student/Resident Lung Cancer Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Primary mediastinal choriocarcinoma (PMC) is an extra gonadal, non-gestational, angioinvasive rare germ cell neoplasm that mostly arises along the midline structures. PMC contains syncytiotrophoblastic cells which secrete human chorionic gonadotropin hormone (hCG). An elevated hCG is considered an important serologic tumor marker in the diagnosis of mediastinal germ cell tumor, in the absence of gestation and with no previous gynecologic malignancy. CASE PRESENTATION: A 39 year-old woman with no past medical history was admitted to the hospital with severe right sided chest pain associated with hemoptysis that started 2 weeks prior to admission. Physical exam revealed decreased breath sounds on the right hemithorax with dullness to percussion. Bloodwork was significant for β-HCG of 6,566 mlU/ml with negative alpha fetoprotein, and normal lactate dehydrogenase. A CT scan of the chest revealed a large necrotic solid mass with numerus enlarged vessels located in the anterior mediastinum (Figure 1). PET scan was negative for any metastatic lesions. Transvaginal ultrasound was negative for intrauterine or ectopic pregnancy. Transthoracic core biopsy showed poorly differentiated choriocarcinoma. Immunohistochemistry staining was positive for β-HCG, placental alkaline phosphatase, and pancytokeratin AE1/AE3 (Figure 2). The tumor was not amenable to surgical resection due to its large size and high vascularity. The patient was started on cisplatin and etoposide followed by etoposide, MTX, Act-D, cyclophosphamide, and vincristine (EMA-CO). After the first course of chemotherapy, the levels of β-HCG markedly decreased. DISCUSSION: PMC is a rare malignancy in both genders, more prevalent in men than in women. The natural process of PMC has been poorly understood. Possible theories include: (1) trophoblastic embolus related to a gestational event after a long period of latency; (2) metastases from a primary gonadal choriocarcinoma; (3) retained primordial germ cells that migrated during embryogenesis. An extensive workup is required to exclude other β-HCG-positive tumors from PMC, such as primary poorly differentiated non-small cell carcinoma of the lung, and gestational metastatic choriocarcinoma. Our patient was found to have a large highly vascular mass in the presence of elevated β-HCG, and absence of primary genital tumor. The histological features showed extensive areas of hemorrhage and necrosis and biphasic cellular population including cytotrophoblastic and syncytiotrophoblastic cells. In contrast to gestational choriocarcinoma, PMC is rapidly progressive and fatal in the great majority of cases with a dismal 5 years survival of less than 5%. CONCLUSIONS: Due to the rarity of PMC, currently there is no consensus regarding treatment guidelines. Thus, case reports such as this contribute to the scant literature to raise the profile of this rare and devastating disease. Reference #1: Ruan Z, Wang S, Wang Z, Jing Y. A rare case of bilateral massive hemothorax from spontaneous rupture of a primary mediastinal mixed germ cell tumor. Ann Thorac Surg. 2012;93:664–666 Reference #2: Bachmann J, Ernestus K, Werner T, et al. Detection of primary choriocarcinoma in the mediastinum by F-18 FDG positron emission tomography. Clin Nucl Med. 2007;32:663–665. Reference #3: Serno J, Zeppernick F, Jakel J, Primary pulmonary choriocarcinoma; cas report and the review of the literature, Gynecologic nad obstetric investigation, vol. 74, no. 2, pp. 171-176,2012 DISCLOSURES: No relevant relationships by Marwah Abduljabbar, source=Web Response No relevant relationships by Sara Mehrsefat, source=Web Response No relevant relationships by jorge otoya, source=Web Response No relevant relationships by Noman Subhani, source=Web Response no disclosure on file for Maria Wallis-Crespo

A Rare Case of Hemophagocytic Lymphohistiocytosis in a Young Adult Male with Mediastinal Mixed Germ Cell Tumor

Child development is a process where the level of maturation reached by a child within his age group can be recognized and quantified [1]...

Primary Mediastinal Malignant Mixed (Non-seminomatous) Germ Cell Tumor Presenting as Superior Vena Cava Syndrome

Abstract Introduction Mediastinal germ cell tumors are commonly seen in children and young adults with male preponderance. They are clinically classified as teratomas, seminomas and nonseminomatous germ cell tumors. Primary mediastinal mixed germ cell tumor falls under the nonseminomatous classification and are very rare. These patients have poor prognoses despite multidimensional strategic approach (chemotherapy, radiotherapy, surgical intervention). Case Discussion A previously well 27-year old male initially presenting with non-productive cough and a right anterior neck mass unresponsive to antibiotic therapy is subsequently diagnosed to be an extra-gonadal germ cell tumor of the anterior mediastinum. Two months through the course of disease, patient’s symptoms have progressed presenting with facial edema, engorged neck veins and cardio-respiratory distress. He is later found to be admitted in the intensive care unit where further work-ups led to the diagnosis of primary mediastinal mixed (non-seminomatous) germ cell tumor. Chemotherapy (cisplatin, bleomycin, etoposide - 1 cycle) and chest radiotherapy (4 sessions) were initiated causing resolution of symptoms. One week after discharge, patient presented with seizures and sudden onset of dyspnea. Patient was brought to the emergency room where he subsequently expired. Discussion This case report presents an account of this rare disease entity from its initial presentation to post-mortem analysis. Primary mediastinal germ cell tumors are rare with a poor prognosis and should be strongly considered in the diagnosis of young men with a mediastinal mass and superior vena cava syndrome.

Medical image of the week: fast-growing primary malignant mediastinal mixed germ cell tumor

Medical image of the week: fast-growing primary malignant mediastinal mixed germ cell tumor

Mediastinal mixed germ cell tumor presenting as empyema

Mixed germ cell tumors are uncommon lesions in the mediastinum, which remain asymptomatic for long periods and often present with complications. We report a case of mediastinal tumor that ruptured into pleural cavity and presented as an empyema. The patient underwent an emergency excision of the mass with decortication.

右血胸を伴った縦隔原発混合性胚細胞腫瘍の1切除例

右血胸を伴った縦隔原発混合性胚細胞腫瘍の1切除例

Mixed germ cell tumor of mediastinum/lung masquerading as hemangioma in fine needle biopsy

The histological predominance of one component in a germ cell tumor can lead to a mistaken diagnosis. Here, we describe a mediastinal teratoma with predominant vascular proliferation (>90%) which on fine needle biopsy was diagnosed as a pulmonary hemangioma. Later, resection specimen revealed other components constituting ~4%, changing the diagnosis while illustrating theimportance of careful evaluation. A 37-year-old Caucasian male with shortness of breath, weight loss, and history of recently resolved pneumonia was diagnosed with hemangioma, after a computed tomography guided fine needle biopsy of a -16.3-cm mediastinal pulmonary mass revealed abundant benign vascular elements. Following tumor excision, ~94% of the sample exhibited predominant vascular elementsThe mass also exhibited rare focal areas of malignant epithelium in a reticular arrangement and undifferentiated pleomorphic cells associated with vascular invasion. These atypical epithelial cells were positive for CD30, pan CK, AFP, β-HCG and CD 117, thusprocuring a diagnosis of mediastinal mixed germ cell tumor. Although mixed germ cell tumors consist of various tissue types, diagnosis can be easily overlooked if one component dominates. Therefore, obtaining adequate representative neoplasm samples, and sectioning the samples thoroughly, searching for coexisting tissue types is critical for accurate diagnosis.

精巣良性腫瘍が併存した縦隔原発混合型胚細胞腫瘍の1例

精巣良性腫瘍が併存した縦隔原発混合型胚細胞腫瘍の1例

Postchemotherapy-related changes in mediastinal mixed germ cell tumor masquerading as a vascular neoplasm

Florid vascular proliferation in teratoma is rare morphological presentation. We present a case of mediastinal germ cell tumor masquerading as a vascular neoplasm in a 14-year-old male who presented with right hemithoracic mass. The initial histopathology of resected mass was suggestive of vascular neoplasm. Fine needle aspiration cytology (FNAC) of right axillary mass with immunohistochemistry on cell block was consistent with metastatic mixed germ cell tumor. Repeat extensive sectioning of the resected mediastinal mass showed focal viable tumor with mainly teratomatous component. Further enquiry into the history revealed patient having received prior chemotherapy; this he received in another hospital before being admitted to our hospital for surgical resection of the mass. The florid vascular proliferation may represent postchemotherapy change or a rare component of germ cell tumor possibly resistant to preoperative chemotherapy.

Malignant Ganglioneuroma Arising from Mediastinal Mixed Germ Cell Tumor

Mixed germ cell tumors with non-germ cell malignant components rarely occur in the anterior mediastinum. We report a case of a 34-year-old man who presented with an anterior mediastinum mass. Mixed germ cell tumor was initially diagnosed based on the pathologic findings of germinoma on thoracoscopic biopsy and clinical findings of elevated serum alpha-fetoprotein and beta-human chorionic gonadotropin. The patient received preoperative chemotherapy and subsequent complete resection of the residual tumor. Pathologic examination of the excised specimen showed predominantly malignant ganglioneuroma and small residual foci of teratoma. To our knowledge, this is the first reported case of a malignant ganglioneuroma arising from mediastinal mixed germ cell tumor.