Carinal Compression from Primary Mediastinal Germ Cell Tumor

Abstract

Mediastinal masses can present as a medical emergency when there is central airway obstruction, superior vena cava (SVC) syndrome, direct mediastinal extension of tumor, or obstruction of the central pulmonary vasculature. Diagnostic evaluation may include the need for invasive tissue biopsy under anesthesia, which can pose several distinct risks for patients. Among the many etiologies of mediastinal tumors, primary mediastinal germ cell tumors are a rare form with a favorable prognosis.

Keywords: airway stenting; interventional pulmonology; mediastinal germ cell tumor; non-seminomatous germ cell tumor; thoracic anesthesia.

Figure 1. CT scan with large mediastinal mass causing critical compression of the trachea down to 4 mm diameter.

The black arrow indicates a critically narrowed tracheal lumen.

Figure 2. Mediastinal CT scan images.

White arrows mark the large mediastinal mass with partial internal calcifications.

Figure 3. Fine needle aspiration of mediastinal mass with malignant cells, Diff-Quik stain, 60× magnification.

Further immunohistochemical testing confirmed non-seminomatous germ cell tumor (NSGCT).

Figure 4. Repeat CT scan after four cycles of chemotherapy and the removal of tracheal stent shows dramatic reduction in mediastinal mass (white arrow), as well as the resolution of tracheal compression (black arrow).