Primary malignant mediastinal germ cell tumors: A single institutional experience

Abstract

Bacground: Primary mediastinal malignant germ cell tumour (PMMGCT) is rare with unsatisfactory prognosis and pose difficulty in management due to lack of guidelines. Methods: All cases of PMMGCT diagnosed and treated between years 2014 to 2018 were retrospectively evaluated for clinico-pathological features, multimodality treatment and follow up. Results: Among a total of five PMMGCT cases, three were seminomatous and two were non seminomatous tumour [Yolk- sac tumour (n-1) and Mixed tumour (n-1)]. Four of these cases were non - metastatic with locally advancement and another one presented with metastasis to supraclavicular lymph node. All patients received platinum based induction chemotherapy. Post-induction chemotherapy, two cases of non seminomatous tumours underwent surgery. Among the three seminoma cases, one patient showed complete metabolic response; one with metastasis succumbed to the disease and the in-operable case of seminoma received local radiotherapy. Conclusion: PMMGCT needs a multi-disciplinary approach for appropriate diagnosis and management. Clinicopathological features like tumour site, extension, histopathological type, tumour stage and serum tumour marker are necessary for prognostication and decision making of further treatment plan.

Nonseminomatous Extragonadal Germ Cell Tumor Presenting As Early Pericardial Tamponade

“…Approximately 85% of patients with mediastinal NSGCTs are symptomatic at the time of diagnosis, with chest pain, hemoptysis, cough, fever, or weight loss being the most common presenting symptoms. Superior vena cava syndrome or pericardial tamponade is occasionally present [6,7]. Our patient presented with cough, shortness of breath, and was in acute distress.…”

“…Our patient had a high AFP and b-hCG with the tumor biopsy showing a yolk sac tumor. He was admitted under the care of the oncology and thoracic surgical services for emergent chemotherapy; the patient will eventually get four cycles of etoposide, ifosfamide, and cisplatin chemotherapy followed by resection of any residual disease with the goal of treatment as a complete cure [7,9].…”

Primary mediastinal germ cell tumours: real world experience in the low middle income (LMIC) setting

“…Even in developed nations, the multidisciplinary management of these tumours poses a challenge. Though GCTs among the adolescent and young population are treated with a curative intent worldwide, the additional challenges faced in LMIC settings are unique and include delayed presentation, higher proportion of treatment abandonment, poor follow up and limited access to more advanced salvage treatments like HDT and ASCT (HDT/SCT) [6][7][8]11]. Our study reports real world outcomes among patients with PMGCTs in a LMIC setting.…”

“…In the recurrent/refractory setting, salvage chemotherapy with or without high dose therapy (HDT) is standard of care [5]. In low middle income countries (LMIC) like ours, the management of GCTs is more challenging due to the higher proportion of patients with extra mediastinal and extra thoracic involvement at diagnosis of PMGCTs, higher rates of treatment abandonment and attrition, limited access to surgical expertise and salvage chemotherapy with HDT/autologous stem cell transplantation (ASCT) at relapse [6][7][8][9]. We reviewed our institutional experience with PMGCTs with an intent to determine the differences in presentation, treatment course and survival outcomes of these patients in the real world LMIC setting.…”

Primary Mediastinal and Testicular Germ Cell Tumors in Adolescents and Adults: A Comparison of Genomic Alterations and Clinical Implications

“…Conversely, mediastinal germ cell tumor (MGCT) represents a small percentage of GCTs arising from the anterior mediastinum [4]. They represent <5% of all GCTs and <4% of all mediastinal neoplasms [5]. Nonseminomatous MGCT represents a more aggressive variant with a five-year overall survival rate of nearly 50%; therefore, they have been placed in the "poor risk" category by the updated analysis of the International Germ Cell Cancer Collaborative Group (IGCCCG) [6].…”