Multimodality treatment of primary mediastinal germ cell tumor with growing teratoma syndrome: a case report

Year 2016, Volume: 1 Issue: 1, 28 - 31, 28.12.2016

Necdet Öz Ahmet Bülent Kargı Ayşegül Kargı Akın Yıldız Saim Yılmaz

Abstract

Germ cell tumors arise from errors occurring during the migration of embryonic stem cells to the gonads. They constitute 10-15% of malignant mediastinal tumors. Thirty-nine years old male patient was admitted with shortness of breath and gynecomastia. Positron emission tomography / Computed tomography (PET/CT) showed hypermetabolic mediastinal mass in the anterior mediastinum. Serum tumor markers were elevated. Mixed germ cell tumor was diagnosed via transthoracic tru-cut biopsy. After three cycles of systemic cisplatin, etoposide and bleomycin treatment, PET/CT showed a decreased metabolic activity but an increase in the size of mass. "Growing teratoma syndrome" was diagnosed. The excision of the mass was performed via a median sternotomy. Then autologous stem cell transplantation was performed. Patients was presented as a successful example of a multimodality treatment of a primary mediastinal germ cell tumor with GTS.

Keywords

Germ cell tumor, mediastinal mass, growing teratoma syndrome, surgery

References

• Hainsworth JD, Greco FA. Nonseminomatous malignant germ cell tumors of the mediastinum. In: Shields TW, Locicero J, Reed CE, Feins RH, editors. General Thoracic Surgery. Philadelphia: Wolters Kluwer Lippincott Williams&Wilkins; 2009. p. 2403-9.
• Kang CH, Kim YT, Jheon SH, Sang S, Sung S, Kim JH. Surgical treatment of malignant mediastinal nonseminomatous germ cell tumor. Ann Thorac Surg 2008; 85:379-84.
• Logothetis CJ, Samuels ML, Trindade A, Johnson DE. The growing teratoma syndrome. Cancer 1982; 50:1629-35.
• Shinagare AB, Jagannathan JP, Ramaiya NH, Hall MN, Van den Abbeele AD. Adult extra gonadal germ cell tumors. Am J Roentgen 2010; 195: 274-80.
• Rankin S. 18F-2-Fluoro-2-deoxy-d-glucose PET/CT in mediastinal masses. Cancer Imaging. 2010; 10(1A): S156-S160.
• Agatsuma T, Koizumi T, Kubo K, Saito G, Kondo R, Yoshida K, et al. Mediastinal growing teratoma syndrome successfully treated by multiple modality therapies. Intern Med 2011; 50: 607-10.
• Sarkaria IS, Bains MS, Sood S, Sima CS, Reuter VE, Flores RM, et al. Resection of primary mediastinal non-seminamatous germ cell tumors: A 28-years’ experience at Memorial Sloan-Kettering Cancer Center. J Thorac Oncol 2011; 6: 1236-41.
• Date H, Kiura K, Ueoka H, Tabata M, Hotta K, Katayama H, et al. Induction chemotherapy, surgical resection, and high-dose chemotherapy for mediastinal nonseminamatous germ-cell tumor. J Thorac Cardiovasc Surg 2003; 130: 1205-6.
• Iyoda A, Hiroshima K, Yusa T, Toyozaki T, Fujisawa T, Ohwada H. The primary mediastinal growing teratoma syndrome. Anticancer Res 2000: 20(5C): 3723-6.
• Kesler KA, Patel JB, Kruter LE, Birdas TJ, Rieger KM, Okeroke IC, et al. The ‘‘growing teratoma syndrome’’ in primary mediastinal nonseminomatous germ cell tumors: Criteria based on current Practice. J Thorac Cardiovasc Surg 2012; 144: 438-43.
• Li-Tzong Chen, Cheng-Lung Chen, and Wei-Shou Hwang. The growing teratoma syndrome. A case of primary mediastinal nonseminomatous germ cell tumor treated with chemotherapy and Radiotherapy. Chest 1990; 98: 231-3.
• Tongaonkar HB, Desmane VH, Dalal AV, Kulkarni JN, Kamat MR. Growing teratoma syndrome. J Surg Oncol 1994; 55: 56-60.
• Walsh GL, Taylor GD, Nesbitt JC, Amato RJ. Intensive chemotherapy and radical resections for primary nonseminomatous mediastinal germ cell tumors. Ann Thorac Surg 2000; 69: 337-44.
• Rodney AJ, Tannir NM, Siefker-Radtke AO, Liu P, Walsh GL, Millikan RE, et al. Survival outcomes for men with mediastinal germ-cell tumors: The university of Texas M.D Anderson Cancer Center experience. Urol Oncol 2012; 30: 879-85.
• Bokemeyer C, Schleucher N, Metzner B, Thomas M,Rick O,Schmoll H-J, et al. First-line sequential high-dose VIP chemotherapy with autologous transplantation for patient with primary mediastinal nonseminamatous germ cell tumours a prospective trial. British J Cancer 2003; 89: 29-35.
• Kuwano H, Tsuchiya T, Murayama T, Sano A, Nagayama K, Yoshida Y, et al. Outcomes of combined modality therapy for patients with stage III or IV mediastinal malignant germ cell tumors. Surg Today 2014; 44: 499-504.