GERMINOMA MEDIASTINUM PDF

Most mediastinal malignant tumors are large and cause symptoms by compressing or invading adjacent structures, including the lungs, pleura, pericardium, and chest wall. Seminomas grow relatively slowly and can become very large before causing symptoms. Rare cases of adult onset acute megakaryoblastic leukemia are associated with malignant mediastinal germ cell tumor. In these cases, the mediastinal germ cell tumor develops before or concomitantly with but not after acute megakaryoblastic leukemia. In several of these cases, the genetic aberrations in the malignant megakaryoblasts were similar to those in the malignant mediastinal germ cells.

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Most mediastinal malignant tumors are large and cause symptoms by compressing or invading adjacent structures, including the lungs, pleura, pericardium, and chest wall. Seminomas grow relatively slowly and can become very large before causing symptoms. Rare cases of adult onset acute megakaryoblastic leukemia are associated with malignant mediastinal germ cell tumor.

In these cases, the mediastinal germ cell tumor develops before or concomitantly with but not after acute megakaryoblastic leukemia. In several of these cases, the genetic aberrations in the malignant megakaryoblasts were similar to those in the malignant mediastinal germ cells. These results and those of other analyses suggest that the two malignancies derive from a common founding clone of cells i.

Others hypothesize a widespread distribution of germ cells to multiple sites during normal embryogenesis, with these cells conveying genetic information or providing regulatory functions at somatic sites. Diagnosis[ edit ] The diagnosis of a mediastinal germ cell tumor should be considered in all young males with a mediastinal mass.

In addition to physical examination and routine laboratory studies, initial evaluation should include CT of the chest and abdomen, and determination of serum levels of HCG and alpha-fetoprotein. Treatment[ edit ] Pure mediastinal seminomas are curable in the large majority of patients, even when metastatic at the time of diagnosis. These tumors are highly sensitive to radiation therapy and to combination chemotherapy. However, the cardiotoxicity of mediastinal radiation is substantial and the standard treatment of mediastinal seminomas is with chemotherapy using bleomycin , etoposide and cisplatin for either three or four day treatment cycles depending on the location of any metastatic disease.

Patients with small tumors usually asymptomatic that appear resectable usually undergo thoracotomy and attempted complete resection followed by chemotherapy. The treatment for mediastinal nonseminomatous germ cell tumors should follow guidelines for poor-prognosis testicular cancer.

Initial treatment with four courses of bleomycin, etoposide, and cisplatin, followed by surgical resection of any residual disease, is considered standard therapy.

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