Anterior mediastinal germ cell tumors

A diagnostic

approach to the mediastinal masses. Non-seminomatous malignant germ cell tumour of the anterior mediastinum in a 25-year-old man with chest pain and high serum level of α-fetoprotein at admission (25.396 ng/ml). Frontal chest radiograph shows a central mass (*). The descending aorta is clearly seen (arrows), indicating that the mass is not within the posterior mediastinum. Multiple nodules in bilateral pulmonary field are also observed. A contrast-enhanced CT scan confirms a mass of low attenuation (*) in the anterior mediastinum that compresses the pulmonary artery. Bilateral lung metastasis (arrowheads) and hilar and subcarinal lymphadenopathy is identified (open arrows)

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mediastinale Keimzelltumoren
Anterior mediastinal germ cell tumors

Germ cell tumors are one of the causes of anterior mediastinal mass, and any of the germ cell histologies may be identified. They can therefore be divided histologically into:

seminoma
non-seminomatous germ cell tumors (NSGCT)
- embryonal cell carcinoma
- choriocarcinoma
- yolk sac tumor
- teratoma: most common
- mixed germ cell tumor

Alternatively, anterior mediastinal germ cell tumors can be thought of as benign and malignant :

benign
- mature teratoma
- mature teratoma with an immature component of less than 50%
malignant
- all others

Mature teratomas are the most frequent histology encountered in the mediastinum (see mediastinal teratoma) and account for ~60% (range 50-70%) of all mediastinal germ cell tumors .

It is difficult to distinguish between the various malignant histologies, and clinical correlation with serum tumor markers (AFP, beta-HCG) and biopsy is usually required.