Primary thymic mediastinal seminoma with florid granulomatous reaction

Gupta, Devika; Rath, Ashutosh; Rathi, KR; Singh, Giriraj

doi:10.4103/0377-4929.188113

Cited by 6 publications

(10 citation statements)

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“…The number of reported cases of primary mediastinal seminoma found incidentally following surgery are small. 1–4% of all mediastinal masses are germ cell in origin with the majority of cases being teratomas and not seminomas [ 1 , 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Seminomas are a type of germ cell tumour that usually occur in the reproductive organs. Extragonadal germ cell tumours, on the other hand, typically present in the midline structures, such as the retroperitoneum and mediastinum [ 1 – 3 ]. Primary mediastinal seminomas are rare and were first described by Woolner et al in 1955 [ 2 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Primary mediastinal seminomas are rare and were first described by Woolner et al in 1955 [ 2 , 4 ]. Only 1–4% of mediastinal tumours are germ cell tumours; with seminomas being the second most common to teratomas [ 1 , 2 ]. Seminomas are slow growing and are often large in size at time of diagnosis with infiltration of local structures [ 1 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…In general, primary mediastinal seminomas have a good prognosis [ 1 , 3 , 6 , 7 ],typically present in men of age 20–40 years 3. , often asymptomatic and found incidentally in 20–30% of cases. Our case is of a 48 year old gentleman with an incidental finding of a primary mediastinal seminoma with florid follicular lymphoid hyperplasia who had undergone an excision of a clinically presumed thymoma.…”

Section: Introductionmentioning

confidence: 99%

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Primary mediastinal seminoma with florid follicular lymphoid hyperplasia: a case report and review of the literature

2021

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Background First described in 1955 Primary mediastinal seminomas are rare. Only 1–4% of mediastinal tumours are germ cell tumors; majority of which are teratomas. They typically present in men aged between 20 and 40 years. Very few cases are reported in the literature. Florid follicular lymphoid hyperplasia can obscure the malignant cells and is a rarer finding still. We present a rare case of a 48 year old man with a primary mediastinal seminoma with florid follicular lymphoid hyperplasia; found following excision of a clinically presumed thymoma. Case presentation A 48 year old man was referred for excision of a thymic mass. The presumed diagnosis was a thymoma; following preoperative investigations. The mass was incidentally found on a radiological imaging. However, the patient did report mid-sternal discomfort on lying flat and breathlessness. The patient underwent a thymectomy via a partial median sternotomy with good recovery. Histological assessment was that the mass was in fact a primary mediastinal seminoma with florid follicular lymphoid hyperplasia. A primary testicular malignancy was excluded and the patient required no further oncological treatment. Conclusions Only 11 cases have previously been reported of primary mediastinal seminoma with florid follicular lymphoid hyperplasia. Although rare, a primary mediastinal seminoma should be considered as a differential diagnosis for presentations with a thymic mass. Tumour markers can be helpful, however are only positive in third of cases. Ultrasound imaging of the gonads is essential to exclude a primary gonadal lesion. Pure seminomas are radiotherapy and chemotherapy sensitive however the mainstay treatment of primary mediastinal seminomas remains surgical excision. Radiotherapy is reserved postoperatively for incomplete surgical margins.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Primary mediastinal seminoma with florid follicular lymphoid hyperplasia: a case report and review of the literature

2021

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“…Our case resulted in a diagnostic dilemma following microscopic examination, as there were no neoplastic cells that were masked by inflammatory cells, along with a florid granulomatous reaction. Only a few mediastinal seminomas with chronic granulomatous inflammation have been reported previously (7)(8)(9). There was a case in which only a mediastinal seminoma and chronic granulomatous inflammation were pathologically accompanied, and they were also mistaken from a small biopsy to be TB, and the diagnosis was delayed (8).…”

Section: E F C B Amentioning

confidence: 99%

Granulomatous reaction of primary mediastinal seminoma leading to diagnostic delay: a case report

Lee¹,

Lim²,

Lee³

et al. 2018

J. Thorac. Dis.

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Primary mediastinal seminoma (PMS) is a rare tumor. PMS can be morphologically related to secondary changes in the form of thymic remnants, cystic degeneration, epithelioid granulomas, fibrotic change, and syncytiotrophoblast-like cells. Ours was an interesting case where a 26-year-old male presented with an incidentally-found anterior mediastinal mass. Even though he had no pulmonary symptoms, the transthoracic co-axial needle biopsy of the mass suggested tuberculosis (TB). However, on follow-up computed tomography (CT) and magnetic resonance image (MRI) in 2 months, the mass slightly increased in size, and a small part of low density or signal intensity appeared, despite the regular anti-TB treatment regimen. Surgical resection was performed, and the resected specimens revealed scattered and irregular-shaped seminoma cells with an intervening chronic granulomatous reaction. The aim of this article is to report a case of PMS in a young male patient who had a granulomatous reaction that mimicked a neoplastic population of cells leading to an erroneous diagnosis of the small biopsy. Therefore, awareness of the secondary changes that can mimic a primary lesion can help with an early correction of this misdiagnosis.

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Thoracic SMARCA4‐deficient undifferentiated tumor with associated granulomatous reaction and response to pembrolizumab

Marshall

Khader

Beasley

et al. 2023

Diagnostic Cytopathology

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Thoracic SMARCA4‐deficient undifferentiated tumor (SMARCA4‐UT) is a rare entity that was recently described in the current World Health Organization Classification of Tumors. These lesions are highly aggressive with dismal prognosis, and most patients present with metastasis at the time of diagnosis. While there are about 100 cases of SMARCA4‐UT described in the literature, there are only few existing reports that describe the cytomorphology of these lesions. We present a patient with masses involving the mediastinum, right lung, right supraclavicular lymph node and right adrenal gland. Subsequent core‐needle biopsy of the right supraclavicular lymph node showed epithelioid to pleomorphic tumor cells with prominent nucleoli and associated granulomatous inflammation. The tumor cells were positive for CD34 and synaptophysin, and were negative for cytokeratins. SMARCA4 and SMARCA2 both showed loss of expression, which led to the diagnosis of SMARCA4‐UT. The patient underwent treatment with pembrolizumab (PD‐1 blocker), carboplatin, etoposide, and radiotherapy, resulting in an almost 55% reduction in the size of the primary tumor. Our case illustrates that an associated granulomatous inflammation might be an uncommon presentation of an already rare malignancy, and awareness of this phenomenon would prevent from mistaking SMARCA4‐UT for other more well‐known entities that can present with granulomas.

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Primary thymic mediastinal seminoma with florid granulomatous reaction

Cited by 6 publications

References 0 publications

Primary mediastinal seminoma with florid follicular lymphoid hyperplasia: a case report and review of the literature

Primary mediastinal seminoma with florid follicular lymphoid hyperplasia: a case report and review of the literature

Granulomatous reaction of primary mediastinal seminoma leading to diagnostic delay: a case report

Thoracic SMARCA4‐deficient undifferentiated tumor with associated granulomatous reaction and response to pembrolizumab

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