scholarly journals Mixed Mediastinal Germ Cell Tumor: A Case Report

Germ cell tumors constitute a heterogeneous group of neoplasms derived from primitive germ cells, arising as a consequence of an embryogenic error. A clinical case of a 16-year-old white male patient, with no previous pathological history or toxic habits, who was admitted to the internal medicine room for presenting a clinical picture of asthenia and anorexia was added, to whom light fever was added in evening schedule. Several examinations were performed, including: Immunohistochemistry, biopsy, Computed Axial Tomography, X-ray of the chest and Mixed germ cell tumor of Mediastinum was diagnosed. Chemotherapy was started. The prognosis of the disease depends on the precociousness with which the diagnosis and treatment are made.

Author(s):  
Faraz S. Vali ◽  
Amit Kyal ◽  
Parul I. Chaudhary ◽  
Sujatha Das ◽  
Aprateem Mukherjee ◽  
...  

Germ cell tumors represent only 20% to 25% of all benign and malignant ovarian neoplasms. Mixed germ cell tumors are a rare variety of non–dysgerminomatous germ cell tumors. They contain two or more elements; the most frequent combination being a dysgerminoma and an EST (Endodermal Sinus Tumor). We present a case of malignant mixed germ cell tumor comprising of yolk sac tumor, embryonal carcinoma and choriocarcinoma. A 13-year-old girl presented with a huge 25 x 18 cm mass in abdomen with raised values of CA-125, hCG, AFP (alpha-feto protein) and LDH (lactate dehydrogenase). She underwent laparotomy followed by unilateral salpingoopherectomy and infracolic omentectomy. Histopathology report revealed malignant mixed germ cell tumor comprising predominantly of EST with elements of embryonal carcinoma and non-gestational choriocarcinoma. Following surgery, she was started on adjuvant chemotherapy (Bleomycin, Etoposide and Cisplatin regimen). Mixed germ cell tumor (YST/EST, non-gestational choriocarcinoma and embryonal carcinoma) is a very rare tumor. Careful initial surgery with adequate staging biopsies followed by combination chemotherapy can greatly improve the prognosis of these patients


2020 ◽  
Vol 22 (1-2) ◽  
pp. 88-92
Author(s):  
Rumita Kayastha ◽  
S Pradhan ◽  
R Acharya ◽  
M Aryal ◽  
A Shrestha ◽  
...  

Primary testicular germ cell tumors (PGCT) can be classified as seminomatous and non-seminomatous germ-cell tumor (NSGCT) types. Mixed germ cell tumors (MGCT), a subtype of NSGCT, contain more than one germ cell components. Here, we present a rare case of a MGCT composed of yolk sack tumor and teratoma which had a continuous large abdominal and retroperitoneal extension. A 43 years old male presented with complaints of discomfort and swelling over the right inguinoscrotal region. Ultrasonography (USG) showed a large ill-defined heteroechoic mass in the right inguinoscrotal region with vascularity and without separate visualization of right testis. Subsequent contrast enhanced Computed Tomography (CT) showed large enhancing mass in the right scrotal sac which was continuous with large abdominopelvic and retroperitoneal mass through the right inguinal canal. Tru-Cut biopsy of the scrotal mass showed MGCT with yolk sac and teratoma component. Patient underwent 6 cycles of chemotherapy followed by Right Radical Inguinal Orchidectomy.


2019 ◽  
Vol 6 (2) ◽  
pp. 611
Author(s):  
Siddhartha Verma ◽  
Heeralal Jakhar

Cryptorchidism is the most common predisposing factor in the development of testicular germ cell tumors. Seminoma is the most common malignancy developing in a cryptorchid testis. A rare case of seminoma with mixed germ cell tumor in an undescended testis is reported here. A 35-year-old male patient presented with swelling in left inguinal region science 1.5year. This  was smooth, firm to hard in consistency, restricted mobility and his left scrotum was empty. Serological markers α-FP, β-HCG, LDH were raised.  Sonography and CT scan revealed a testicular tumor in undescended left inguinal testis. High inguinal orchidectomy was done. Patient had an uneventful recovery. The histopathology report of biopsy revealed a seminoma with mixed germ cell tumor. Early diagnosis and management of the undescended testicle are needed to preserve fertility and improve early detection of testicular malignancy. Therapy should begin between six months and two years of age and may consist of hormone or surgical treatment.


1987 ◽  
Vol 5 (8) ◽  
pp. 1290-1294 ◽  
Author(s):  
C R Nichols ◽  
N A Heerema ◽  
C Palmer ◽  
P J Loehrer ◽  
S D Williams ◽  
...  

Several case reports have suggested an association of primary mediastinal germ cell tumor (PMGCT) and Klinefelter's syndrome (KS). In an effort to confirm this association, 22 patients with mediastinal germ cell tumors had chromosome studies performed in a prospective fashion. Five patients (22%) had karyotypic or pathologic evidence of KS. All of the patients with KS had germ cell tumors of the nonseminomatous subtype and were relatively young (median age, 15 years). The literature confirms the findings of a young median age (18 years), nonseminomatous subtype, and mediastinal location of the germ cell neoplasm. We conclude that patients with KS are predisposed to the development of mediastinal nonseminomatous germ cell cancers.


2020 ◽  
Vol 3 (1) ◽  
pp. 01-03
Author(s):  
Sardar Islam

A 35 year’s old male presented with right testicular swelling for last six month. He developed hemoptysis and mild dyspnea for 2 weeks. Ultrasonography revealed testicular malignancy with multiple heterogenecity. CT scan of the abdomen did not reveal any lymph node metastasis. His X-ray chest showed extensive pulmonary metastasis. All three tumor markers were raised. Histology was suggestive of mixed germ cell tumor with a rare combination of Seminoma and Choriocarcinoma. Because of this rare combination of 2 varieties of testicular germ cell tumor and advanced systemic metastasis we presented this case.


2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Houda Alatassi ◽  
Brittany E. O’Bryan ◽  
Jamie C. Messer ◽  
Zhenglong Wang

Adult extrarenal nephroblastoma is a very rare tumor. Nephroblastoma arising from primary testicular germ cell tumor is exceedingly rare. To our knowledge, only three cases have been reported in the English literature. We report a case of a 19-year-old man who presented with a large right testicle. Image studies showed a large retroperitoneal mass along with liver and lung metastases. Orchiectomy demonstrated a mixed germ cell tumor composed of yolk sac tumor, embryonal carcinoma, and mature and immature teratoma with a significant portion of nephroblastoma. The patient received chemotherapy and no recurrence was noted during six months of followup. WT-1 expression was also studied due to the lack of consistency of its expression in testicular nephroblastoma in the literature. We also present a discussion and review of the literature due to its rarity, which indicate an adverse prognosis for patients with nephroblastoma components receiving standard chemotherapeutical regimes for testicular germ cell tumors.


Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3694-3694 ◽  
Author(s):  
Sonia John ◽  
Mohammed Abdul Muqeet Adnan ◽  
Mohammad O. Khalil ◽  
George Selby ◽  
Adam S. Asch ◽  
...  

Abstract Background and Aim: The association of mediastinal germ cell tumors and acute megakaryoblastic leukemia has been known for many years. Characterization of this association is not well reported systematically in the literature. We hereby present this systematic review to describe the salient features of this association, treatment options and overall prognosis. Material and Methods: A systematic review of PUBMED, Medline and EMBASE databases via OVID engine was conducted to search for primary articles and case reports under keywords “germ cell tumors” and “acute myeloid leukemia”. Search was extensive from 1946 to 2014; all the cases that were written in English language in pediatric and adult patients were included. The search yielded 679 results and was individually examined by two authors. All the studies that described acute lymphoblastic leukemia or other malignancies aside from AML were excluded. A total of 25 studies reported mediastinal germ cell tumors (MGCT) and acute megakaryoblastic leukemia (M7). We also included in this analysis, one additional case with mediastinal germ cell tumor with subsequent development of acute megakaryoblastic leukemia that was recently diagnosed and treated at our institution. Results: After our extensive review of the literature a total of 25 previous patients with MGCT + M7 were found from 1946-2014. With the inclusion of our case we report a total of 26 cases from 1946-2014.Twenty of the included patients were males and in 6 cases there was no mention of the gender. Median age at diagnosis of MGCT was 23 years (range - 15 to 36 y). In 92 % of cases the germ cell tumor was of non-seminomatous origin with 27% cases reporting teratoma and 40.7 % of cases reporting embryonal carcinoma. All the reported cases were stage III and had elevated tumor markers with significant elevation in serum AFP compared to beta-HCG. MGCT occurred prior to appearance of leukemia in 46% of cases and concomitantly in 30% of cases. The rest of the cases did not describe the sequence of disease occurrence. M7 leukemia was never reported prior to the appearance of GCT. All the patients were treated with platinum based chemotherapy which was primarily directed towards management of the germ cell tumors. The time from diagnosis of MGCT to development of M7 leukemia ranged from 9 weeks to 39 months with the median time being 4 months. Median time to death from the initial diagnosis of NSGCT was 6 months (range - 3 to 39 months). Only one reported case with MGCT+M7 combination was successfully treated with an allogenic stem cell transplant for the M7 leukemia with surgical resection of the mediastinal mass. Among the cases that reported cytogenetic abnormalities, trisomy 8 and complex cytogenetics were reported in 18.6 % cases each and hyperdiploidy was reported in 22 % cases. Surprisingly, Klinefelters syndrome (47, XXY) that is historically associated in 20 % of cases of mediastinal germ cell tumors was only reported in one case in this review. The i(12p) abnormality was reported only in 14.8 % of cases. Conclusion: Patients with history of mediastinal germ cell tumors are at higher risk of developing acute leukemia especially the megakaryoblastic subtype. This warrants long term follow up of such patients with regular monitoring of blood counts and a high degree of suspicion for hematological malignancies. In selected cases, allogeneic stem cell transplant may be considered in those who achieve leukemia remission after optimal surgical resection. In spite of the advances in chemotherapeutic options, the overall outcome in patients with mediastinal germ cell tumors who have acute megakaryoblastic leukemia remains poor. Disclosures No relevant conflicts of interest to declare.


2019 ◽  
Vol 31 (3) ◽  
pp. 395-398 ◽  
Author(s):  
Vincent J. Tavella ◽  
Jessica N. Walters ◽  
Lisa M. Crofton ◽  
Tanya LeRoith

A 5-y-old backyard Araucana–Americana rooster was presented to the regional diagnostic laboratory with a history of progressive lethargy and respiratory signs. Autopsy revealed a single large mass of testicular origin in the coelomic cavity, causing compression of other organs. Histologically, the mass was 1 neoplasm with mixed components of 2 different germ cell tumors, namely a teratoma composed of elements of all 3 primordial germ cell lines (ectoderm, mesoderm, and endoderm), and a seminoma consisting of round or polygonal cells arranged in sheets supported by a scant fibrovascular stroma. Teratomas and seminomas are both considered to be uncommon neoplasms in poultry medicine. A testicular teratoma is composed of mature embryonic tissue derived from at least 2 of the 3 germinal layers. Seminomas and teratomas both arise from the germinal epithelium of seminiferous tubules and are classified as germ cell tumors. This neoplastic mass thus is a rare case of a mixed germ cell tumor.


2012 ◽  
Vol 2012 ◽  
pp. 1-5
Author(s):  
Toshihide Takahashi ◽  
Eiichi Ishikawa ◽  
Yosuke Masuda ◽  
Tetsuya Yamamoto ◽  
Taiki Sato ◽  
...  

Intracranial nongerminomatous germ cell tumors (NGGCTs) in unusual locations are extremely rare. Here, we report a case of a yolk sac tumor in the frontal lobe in a middle-aged patient. A 42-year-old man was admitted to our hospital for headache and nausea. Magnetic resonance imaging (MRI) showed an enhanced mass lesion with a marked cyst component. The serum alpha-fetoprotein (αFP) level was extremely high. Histological examination of specimens after subtotal removal revealed a primary mixed germ cell tumor with extensive yolk sac tumor elements, often referred to as an intracranial “yolk sac tumor.” The preoperative diagnosis of NGGCTs in unusual age and locations is extremely difficult. Clinicians should consider the possibility of NGGCTs, including yolk sac tumors, when intracranial tumors with unusual MRI findings are encountered.


2016 ◽  
Author(s):  
Priyanka Soni ◽  
Shalini Mishra ◽  
Sandeep Jain ◽  
Gauri Kapoor

Background: Germ-cell tumors (GCT) are the commonest ovarian neoplasm in the first two decades of life. Aim: To study the profile of ovarian GCT in children and their outcome. Methods: Retrospective study of all cases of malignant ovarian GCT in the pediatric age (up to 18 years) was done from January 2002 to December 2015. The medical records of all admitted cases during this period were reviewed and the data was analysed with respect to age at diagnosis, clinical presentation, tumor markers, surgical stage, tumor histology, therapy, clinical course, and outcome. Results: Girls with malignant ovarian GCT were seen at our institute during the study period. Out of these 25 underwent treatment. Mean age at presentation was 11.7 years (range: 3-18 years). Abdominal pain was the commonest presentation. Twelve (47.3%) had right sided disease, 11 (42%) had left sided disease and 2 had bilateral disease. Twelve cases (57.8%) were diagnosed as stage I disease, 5 (10.5%) as stage II, 7 (26.3%) as stage III and 1 (5.2%) as stage IV. Elevated AFP >1000 was found in 9 (47.3%), elevated B-HCG (>50) in 7 (42%) and elevated LDH (>1000) in 7 (36.8%) patients at presentation. Twenty (73.6%) patients underwent surgery prior to chemotherapy out of which 4 (21%) patients presented after undergoing surgery at other centre. Fourteen (57.8%) patients received 4 cycles of BEP based chemotherapy, 6 (21%) received 3 cycles, 2 (10.5%) received 2 cycles and 1 patient did not receive any chemotherapy as it was mature teratoma. The most common histology was dysgerminoma in 8 (42%) patients followed by mixed germ cell tumor in 4 (21%), teratoma in 3 (15.7%), embryonal carcinoma in 2 (10.5%) and yolk sac tumor and mature teratoma in 1 patient each. Four (21%) patients had relapse on contralateral side which was salvaged. 1 patient presented with relapse who underwent only surgery outside, 1 patient had ovarian torsion. Median follow up is 27months. The event free survival rate was 78.9%. Conclusion: This study confirms an excellent outcome for girls with ovarian germ cell tumor. Patients with advanced surgical stage relapsed frequently. The mainstay of treatment is fertility preserving surgery and cisplatin-based chemotherapy.


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