Immature mediastinal teratoma with unusual histopathology

Abstract

Germ cell tumors (GCTs) represent a well-recognized group of heterogeneous neoplasms with diverse clinical, histopathological, diagnostic, and prognostic characteristics. We present a rare case of a locally aggressive, chemotherapy-resistant immature mediastinal teratoma with a peculiar histological finding of a multilineage somatic-type malignant degeneration. A 21-year-old male patient presented with a 3-week history of persistent, blood-tinged productive cough and shortness of breath. A contrast-enhanced computed tomography (CT) scan of the chest showed a heterogeneous mass occupying the right hemithorax and abutting on adjacent structures. CT-guided biopsy was consistent with immature teratoma. Combination chemotherapy with bleomycin, etoposide, and cisplatin was initiated, albeit without success; the mass showed interval progression in size, and surgical resection through clamshell incision was performed. Histological assessment of the resected mass confirmed the diagnosis of immature teratoma and revealed an extensive multilineage malignant differentiation into sarcomatous, carcinomatous, and melanomatous components. The patient underwent an uneventful recovery but presented 2 months later with extensive liver and bone melanomatous metastases. In this report, relevant findings from the literature are also highlighted. Despite being exceptionally rare, such tumors carry poor prognosis. Understanding the clinicopathological characteristics and biological behavior of such tumors may provide an insight into interventions tailored to improve the otherwise dismal disease outlook.

Large mediastinal germ cell tumor with disease progression during systemic therapy

“…identified that patients, such as ours, who have increased tumor size despite decreasing tumor marker levels pose a challenge in determining whether systemic therapy is effective. This is possibly due to changing tumor characteristics and the rare somatic-type malignant transformation within the tumor during neoadjuvant therapy [ 3 , 7 ]. Teratomas with malignant transformation have a worse prognosis with high recurrence rates and poor survival [ 8 ].…”

“…Five-year survival rate for patients with non-seminomatous mediastinal GCT is 30-45% [ 2 ]. GCTs are usually chemosensitive and first-line therapy is cisplatin-based chemotherapy, followed by surgery [ 3 ].…”

Effects of Modified Subxiphoid Thoracoscopic Surgery and Traditional Surgery On Pain Mediators and Pain Stress Levels in Patients With Anterior Mediastinal Teratoma

“…If there is bleeding during the operation, they can be quickly transferred to the central thoracotomy. Because the posterior sternal space has been separated previously, the time of the transfer thoracotomy can be signi cantly shortened, and the safety of the operation is greatly improved [20]. Surgical trauma can promote the production of in ammatory factors such as NO, IL-6, IL-β, and other in ammatory factors, which can increase the activity of phospholipase A2 through G protein-coupled receptors, and promote the production of prostaglandins and arachidonic acid.…”

Case Report: The Complete Remission of a Mixed Germ Cell Tumor With Somatic Type Malignancy of Sarcoma Type With a GCT-Oriented Therapy: Clinical Findings and Genomic Profiling

“…The three most important favorable prognostic factors, independent by stage and risk category according to the International Germ Cell Cancer Collaborative Group (IGCCCG) classification, are as follows: non-primitive neuroectodermal tumor histology, primary gonadal tumor site, and low number of chemotherapy regimens administered before TMT diagnosis (16). Although the rarity of GCTs with malignant transformation have not permitted the generation of a strong body of evidence, it is agreed that a surgical approach with complete resection is the standard treatment, independent of disease stage (5,17,18). However, there is not yet a clear standard of care for target chemotherapies in these neoplasms because there are only a few retrospective case series with different somatic components and heterogeneous results (13)(14)(15)(19)(20)(21)(22).…”