Posters
Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Background: Germ cell tumors (GCT) are neoplasms arising in the testicles (1). Rarely these tumors can grow outside of the reproductive organs without involving them, acquiring the name of extragonadal GCT (2). Mediastinal extragonadal GCT is further divided into seminomatous, non-seminomatous (yolk sac tumor, choriocarcinoma and/or embryonal cell tumor), mature teratoma, and immature teratoma according to the histological pattern (2).
Case Presentation: 24-year-old-male patient presented to the ER with complaints of a persistent cough of one-month duration accompanied by orthopnea, pleuritic chest pain, and worsening shortness of breath. The patient denied weight loss, testicular pain, night sweats, fever, or hemoptysis. Vital signs on admission were stable. CXR showed a large mass-like density overlying the right hilum. CT chest with contrast showed a 13 cm anterior mediastinal mass with a right loculated pleural effusion. Biopsy was performed with immunohistology compatible with nonseminatomous germ cell tumor. Serological tumor markers including Alpha-fetoprotein, LDH and Beta HCG were significantly elevated. AFP 1,680.4, LDH 399, Beta HCG 113 and CEA 1.3 supported this diagnosis.
Conclusion: Nonseminomatous extragonadal GCT is a rare but aggressive neoplasm that arises in the anterior mediastinum. Statistically, they occur more often in men than in women, commonly between the ages of 20 and 40 years old. Treatment with chemotherapy followed by surgical resection of the mass is recommended and should be initiated as soon as the diagnosis is made. Our patient opted to be transferred to MD Anderson Cancer Center for a higher level of care.
Academic/Professional Position
Resident
Academic/Professional Position (Other)
PGY2
Mentor/PI Department
Internal Medicine
Recommended Citation
Guedez-White, Rosa; Loftis, Christine E.; and Abreu, Ricardo, "Challenge of Diagnosing and Treating a Mediastinal Mass in a Young Patient" (2023). Research Symposium. 30.
https://scholarworks.utrgv.edu/somrs/theme1/posters/30
Included in
Challenge of Diagnosing and Treating a Mediastinal Mass in a Young Patient
Background: Germ cell tumors (GCT) are neoplasms arising in the testicles (1). Rarely these tumors can grow outside of the reproductive organs without involving them, acquiring the name of extragonadal GCT (2). Mediastinal extragonadal GCT is further divided into seminomatous, non-seminomatous (yolk sac tumor, choriocarcinoma and/or embryonal cell tumor), mature teratoma, and immature teratoma according to the histological pattern (2).
Case Presentation: 24-year-old-male patient presented to the ER with complaints of a persistent cough of one-month duration accompanied by orthopnea, pleuritic chest pain, and worsening shortness of breath. The patient denied weight loss, testicular pain, night sweats, fever, or hemoptysis. Vital signs on admission were stable. CXR showed a large mass-like density overlying the right hilum. CT chest with contrast showed a 13 cm anterior mediastinal mass with a right loculated pleural effusion. Biopsy was performed with immunohistology compatible with nonseminatomous germ cell tumor. Serological tumor markers including Alpha-fetoprotein, LDH and Beta HCG were significantly elevated. AFP 1,680.4, LDH 399, Beta HCG 113 and CEA 1.3 supported this diagnosis.
Conclusion: Nonseminomatous extragonadal GCT is a rare but aggressive neoplasm that arises in the anterior mediastinum. Statistically, they occur more often in men than in women, commonly between the ages of 20 and 40 years old. Treatment with chemotherapy followed by surgical resection of the mass is recommended and should be initiated as soon as the diagnosis is made. Our patient opted to be transferred to MD Anderson Cancer Center for a higher level of care.