Primary malignant tumours of the mediastinum and their management

Effective treatment for malignant mediastinal teratoma

Primary malignant mediastinal teratoma is a rare tumour previously regarded as inevitably fatal. In a series of eight male patients with a mean age of 24 years five remain alive and well. All patients showed raised serum concentrations of human chorionic gonadotrophin or alpha fetoprotein. The patients were treated with intermittent combination chemotherapy that included cisplatin. Six patients responded to chemotherapy with a fall in human chorionic gonadotrophin or alpha fetoprotein to near normal levels and they then had radical excision of the remaining tumour. Living malignant tumour was found in four of the specimens and these patients received postoperative chemotherapy. One patient died after eight months and the remaining five patients are alive and well 13-136 months after the start of treatment. The two patients who did not undergo surgery died at one month and 15 months. Intermittent combination chemotherapy and carefully timed radical excision of these tumours would appear to have produced better results than have been reported in other series.

Primary mediastinal trophoblastic teratomas

Three cases of primary mediastinal trophoblastic teratoma are described. One patient died from respiratory failure during the initial chemotherapy, Another patient with advanced disease is now apparently free from disease after multiple-drug chemotherapy. The third patient is alive and well four years after a combination of surgery, radiotherapy, and multiple-drug chemotherapy. In the diagnosis and assessment of response to treatment in these tumours emphasis is placed on the measurement of the tumour cell markers, chorionic gonadotrophin and alpha-fetoprotein, by radioimmunoassay. The efficacy of multiple-drug regimens is discussed together with a review of the literature.

Mediastinal cavernous haemangioma

The case of a patient with a mediastinal cavernous haemangioma and other malformations is described and discussed.