Management of the primary malignant mediastinal germ cell tumors: experience with 54 patients

Abstract

BackgroundPrimary malignant mediastinal germ cell tumor (PMMGCT) is rare and sometimes the prognosis of the patients with PMMGCT is not very satisfactory.MethodsA total of 54 patients with PMMGCT in a follow-up from 1990 to 2009. We evaluated the role of the surgical treatment and the effect of multimodality treatment strategy for patients with PMMGCT.ResultsFifty-two patients underwent surgical resections, while the other two patients just received chemoradiotherapy. Among the 52 patients, 28 cases received preoperative adjuvant therapy and 24 cases underwent surgery as initial treatment; 30 cases with complete resections, 18 cases with partial resections and 4 cases with only biopsies. There was no perioperative mortality. Histopathologic results revealed 18 cases of seminomas and 36 cases of nonseminomatous germ cell tumors (NSGCT). The last follow-up showed that 17 patients were alive, including 11 patients with seminoma and 6 patients with NSGCT. The 5-year overall survival rate of patients with seminomas was 87.7%. The 3-year and 5-year overall survival rates of patients with NSGCT were 47.4% and 23.0%, respectively.ConclusionsIt could be concluded that a complete surgical resection of PMMGCT after chemoradiotherapy showed favorable long-term survival. Patients with pure seminomas have a better prognosis compared with that with NSGCT.Virtual slidesThe virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1676987232116837.

Mediastinal Germ Cell Tumors in Pediatric Patients: A Report From the Italian Association of Pediatric Hematology and Oncology

“…In this respect, published studies regarding these tumors include either pediatric cases extracted from adult series or children cared for over a long period with treatment modalities varying over the years. This confirms the rarity of the disease and explains the low number of patients available for analysis …”

“…Only 2–4% of these tumors originate in the mediastinum. Malignant mediastinal GCTs are rarely encountered and case series have been reported by only a few centers …”

“…An OS of >80% has been reported in different studies for patients under 18 years of age suffering from malignant mediastinal GCTs treated with a multidisciplinary approach based on surgery and chemotherapy . Multidrug combinations vary in different long‐term studies . However, some studies on adult populations report worse outcome with survival rates at 5 years ranging from 23% to 47% .…”

“…Multidrug combinations vary in different long‐term studies . However, some studies on adult populations report worse outcome with survival rates at 5 years ranging from 23% to 47% . Reasons for these differences are still unclear.…”

“…This confirms the rarity of the disease and explains the low number of patients available for analysis. [1][2][3] Even though treatment of pediatric GCTs is well established, mediastinal GCTs still represent a challenge for both adult and pediatric oncologists. Unlike their gonadal counterpart, mediastinal CGTs often require major surgical procedures to achieve adequate resection: infiltration of vital organs and vessels is a nonnegligible risk factor to be considered prior to surgery, even if resection is in most cases a critical element for favorable outcome.…”