Yolk Sac Tumor in the Anterior Mediastinum Presenting as Acute Pericarditis

Abstract

Patient: Male, 20-year-old Final Diagnosis: Mediastinal yolk sac tumor • yolk sac tumor Symptoms: Chest pain • cough • sensation of fullness in the neck Medication: — Clinical Procedure: Mediastinal biopsy Specialty: Cardiology • General and Internal Medicine • Oncology • Pathology Objective: Rare disease Background: Mediastinal masses can originate from anatomical structures normally located in the mediastinum, or from structures that travel through the mediastinum during embryogenesis. Initial presenting symptoms usually vary from shortness of breath, cough, chest pain, and superior vena cava syndrome to nonspecific constitutional symptoms (eg, fever, weight loss, fatigue). However, the initial presentation of a mediastinal mass with acute pericarditis has not been reported in the literature as far as we know. Case Report: A 20-year-old man presented to the Cardiology Clinic with chest pain and new pericardial effusion on echo-cardiography, both fulfilling the diagnostic criteria of acute pericarditis. The patient also had venous engorgement on the neck, and a chest X-ray followed by computed tomography imaging showed a large mediastinal mass. The serum tumor marker α-fetoprotein (AFP) was markedly elevated. The biopsy and immunohistochemistry revealed a high-grade malignant neoplasm – yolk sac tumor, which is a type of non-seminomatous germ cell tumor. The acute pericarditis resolved after administration of NSAID and colchicine. The patient was then started on chemotherapy. Conclusions: The discussed case shows the rare presentation of an anterior mediastinal mass with acute pericarditis. This emphasizes the importance of a thorough review of systems and critical analysis of every sign and symptom at the time of initial presentation, which helps the physician to obtain appropriate imaging studies early in the course, leading to an early diagnosis and treatment of the disease, such as in this case of an extremely rare germ cell tumor.

Primary mediastinal yolk sac tumor: A case report and literature review

“…The following key words were used for the database search: “yolk sac tumor,” “mediastinum,” “mediastinal.” A total of 73 articles were retrieved, in which 22 articles on the therapy and prognosis of PMYST were extracted, including 16 case reports and 6 case series, involving 52 patients in total. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 Out of all the patients, only six female cases were reported. The ages of all the patients ranged from 1 to 73 years old with a mean age of 23.64 years.…”

“…In PubMed, the English case reports and case series of PMYST during the past decade were searched. The following key words were used for the database search: “yolk sac tumor,” “mediastinum,” “mediastinal.” A total of 73 articles were retrieved, in which 22 articles on the therapy and prognosis of PMYST were extracted, including 16 case reports and 6 case series, involving 52 patients in total 5–26 . Out of all the patients, only six female cases were reported.…”

Primary germ cell tumours of the mediastinum: A review with emphasis on diagnostic challenges

“…Patients with PGMCTs can be asymptomatic for a long time and usually present with symptoms such as chest pain, chronic cough, dyspnoea and/or dysphagia. These symptoms are caused by large mediastinal masses, 6 that can rarely also lead to pericarditis 47 or seizures 48 . Other severe symptoms include haemoptysis, 49 superior vena cava syndrome 50 or cardiac thrombosis 51 .…”