Primary mediastinal seminoma

The role of radiotherapy in the treatment of primary mediastinal seminoma

Nine patients with primary mediastinal seminoma were treated with radiotherapy. All patients achieved complete response on chest radiography. None of the three patients treated with whole mediastinal irradiation relapsed. Four of the six patients with involved-field irradiation had marginal relapses, suggesting the efficacy of the whole mediastinal irradiation.

Primary mediastinal seminoma

Two new cases of primary mediastinal seminoma are presented and 126 cases from the literature are analysed. Radiotherapy, alone or combined with surgery, is thought by some authors to be the treatment of choice and the role of chemotherapy is uncertain. We propose a classification by which it is possible to compare various therapeutic approaches and to establish their value.

Primary mediastinal germinomas in females: a case report and review of the literature

Primary mediastinal germinomas in females are rare. Long-term survival ranges from 50 to 81%, depending on the initial extent of disease. Initial spread occurs intrathoracically and to regional nodes with late hematogenous dissemination. The roles of surgery, radiation therapy, and chemotherapy are discussed.

Coarctation of the aorta from a mediastinal germ cell tumor: a case report

A 20-yr-old male had compression of the thoracic aorta by a large malignant mediastinal germinoma. The symptoms and signs that simulated coarctation of the aorta included hypertension, markedly decreased femoral pulses, and a systolic murmur that radiated to the back. Following X-ray therapy, the femoral pulses were palpable and the blood pressure became normal. To our knowledge, compression of the aorta by a malignant teratocarcinoma with manifestations mimicking coarctation of the aorta has not been reported.

Humoral antibodies against spermatopoietic cells associated with mediastinal germinoma

A case of mediastinal germinoma in a 21-yr-old male is reported. The neoplasm exhibited a morphology similar to that of a testicular seminoma and was heavily infiltrated by lymphocytes and plasma cells. Germinal centres were also present in lymph follicles. Humoral antibodies (IgG), specific for spermatopoietic tissue, were present in the patient's serum. Antibody titres declined after surgical removal of the germinoma over a period of 2 yr, and antibody is no longer detectable at the present time. The implications of this observation are discussed with regard to defence mechanisms of the tumour host, and to the histogenesis of these rare neoplasms.

Primary malignant germinal tumors of the mediastinum. A study of 24 cases

The malignant germinal tumors found in the testis (seminoma, teratocarcinoma, embryonal carcinoma, choriocarcinoma, and mixtures of these) can originate in the anterior mediastinum. An occult testicular tumor must be sought, but primary mediastinal germinal tumors constitute a true entity. The details of 24 such patients treated at Walter Reed General Hospital are presented. Of 19 patients who died, 2 were women; postmortem examination of the testes of 13 men failed to reveal a primary tumor. Five patients are alive and well with no testicular abnormality. It is important to distinguish the histopathologic types. Seminomas are readily controlled with modest doses of irradiation. Embryonal carcinomas are also radiocurable with somewhat higher doses; 2 long-term disease-free survivors are reported. Teratocarcinomas are highly malignant and require higher doses for control. Choriocarcinomas progress so rapidly that chemotherapy is necessary.

Seminoma of the anterior mediastinum

Primary pure cell seminoma of the mediastinum is a rare and potentially fatal lesion. Encroachment on or invasion of adjacent structures is common, as are distant metastases. The differentiation between pure cell seminomas and mixed germ cell tumors should be made since the extreme radiosensitivity of seminomas improves the prognosis. The presence of metastases from primary mediastinal seminomas, as with testicular germinomas, need not be a deterrent to long-term cure. Recommended therapy consists of total or subtotal removal, radiation therapy (2,500 to 3,500 rads delivered over 2 to 4 weeks), and, in some patients, chemotherapy. A patient who was successfully treated with subtotal removal and irradiation is presented.

Primary malignant tumours of the mediastinum and their management

Primary malignant tumours of the mediastinum are difficult clinical problems in thoracic surgery from both diagnostic and therapeutic points of view. Three cases of malignant seminoma of the mediastinum have been documented, thus bringing the total number of cases reported in the literature to 78. A case of metastasis to the subcutaneous tissue in malignant thymoma has been documented. Because of the multiple-cell types of these tumours and their ill-defined extent due to involvement of adjacent structures, surgery is often difficult. Radiotherapy along with chemotherapy has a definit place in their management, either as a primary treatment in inoperable cases or as a supplement to surgery if the condition is operable.