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Case Reports
. 2021 Jun 18;16(1):892-898.
doi: 10.1515/med-2021-0293. eCollection 2021.

Mediastinal mixed germ cell tumor: A case report and literature review

Xianwen Hu  1   2 , Dandan Li  3 , Jinhua Xia  4 , Pan Wang  1 , Jiong Cai  1
Affiliations
Case Reports

Mediastinal mixed germ cell tumor: A case report and literature review

Xianwen Hu et al. Open Med (Wars). .

Abstract

Mixed germ cell tumor (MGCT) mainly occurs in young women's ovaries and men's testicles and rarely occurs outside the gonad. Fewer than 10 cases of mediastinal MGCT are available in PubMed, Embase, and other databases in English, while mediastinal MGCT with three pathological components, such as yolk sac tumor, immature teratoma, and embryonal carcinoma, has not been reported previously. A 12-year-old male sought medical attention for chest discomfort and underwent a computed tomography (CT) scan. A large soft tissue mass occupying most of the left thoracic cavity and mediastinum was detected. A CT-guided biopsy was performed, and an MGCT was diagnosed with pathological components, including yolk sac tumor, immature teratoma, and a small amount of embryonal carcinoma. Due to the large size of the tumor, the patient was treated with an EP regimen (etoposide + cisplatin) and paclitaxel + ifosfamide + cisplatin interstitial chemotherapy. The patient was followed up for 6 months and was alive with the disease. To the best of our knowledge, this is the 10th patient with MGCT in the mediastinum. The incidence of mediastinal MGCT is low, but it should still be considered one of the differential diagnoses of isolated pleural fibroma and neurogenic tumors.

Keywords: case report; computed tomography; mediastinal; mixed germ cell tumor.

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Conflict of interest statement

Conflict of interest: The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The chest X-ray showed a large dense shadow with an unclear boundary in the left lung field, and the heart was obviously compressed and shifted to the right.
Figure 2
Figure 2
(a) Chest CT mediastinal window showed a huge soft-tissue density mass shadow in the left mediastinum, with unclear boundary, multiple nodular low-density areas (black arrow), and speckled high-density calcification foci (white arrow). (b) Contrast-enhanced CT revealed mild heterogeneous enhancement of the lesion, with nodular nonenhanced necrotic area (white arrow). (c) CT image of chest in coronal position. This coronal contrast-enhanced chest CT image clearly shows the extent of the mass, with the mediastinum slightly shifted to the right by the compression of the tumor (white arrow).
Figure 3
Figure 3
Hematoxylin-eosin staining (a), 40 times magnification: microscopically, there were obviously degenerate fusiform and ovoid tumor cells with loose reticular arrangement, hyperchromatic nuclei, inconsistent cell sizes, and can see the fat composition between the cells. Immunohistochemical staining showed tumor cells positive for AFP (b), CK (c), CD117 (d), glypican-3 (e), SALL4 (f), vimentin (g), and Ki-67 (h).
Figure 4
Figure 4
(a) PET/CT examination of the patient with mediastinal MGCT after chemotherapy; whole-body MIP (maximum density projection) images showed large patches of slightly increased radioactivity uptake in the left lung field (black arrow), SUVmax 5.2. (b) Axial PET/CT fusion images showed varying levels of uptake of radioactive tracers in the lesions, but no uptake in the cystic necrosis area (white arrow). (c) Coronal PET/CT fusion image.
Figure 5
Figure 5
Kaplan–Meier OS. (a) OS in all cases. (b) OS by treatment. MST, median survival time.
See this image and copyright information in PMC

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