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| __NOTOC__
| | #REDIRECT [[Mediastinal mass differential diagnosis]] |
| {{SI}}
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| {{CMG}} {{AE}} {{MV}}
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| {{SK}} M-GCTs;
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| ==Overview==
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| '''Mediastinal germ cell tumor''' is a extragonadal [[tumor]] derived from [[germ cell]] remnants in the [[mediastinum]] and a cause of anterior mediastinal mass.<ref >{{Cite journal | author = Alan Sandler| year = 1997 | url = https://www.thieme-connect.com/ejournals/abstract/10.1055/s-2007-1009353 | title = Mediastinal Germ Cell Tumors| journal = Semin Respir Crit Care Med| volume = 18| issue=4 | page = 383-392 | doi=10.1055/s-2007-1009353}}</ref><ref>{{Cite web|url=http://emedicine.medscape.com/article/359110-overview| title=Mediastinal Germ Cell Tumor Imaging }}</ref> Malignant germ cell tumors of the mediastinum are uncommon, representing only 3 to 10% of tumors originating in the mediastinum.
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| ==Historical Perspective==
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| *Mediastinal germ cell tumor was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
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| *In [year], [gene] mutations were first identified in the pathogenesis of mediastinal germ cell tumor.
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| *In [year], the first [discovery] was developed by [scientist] to treat/diagnose mediastinal germ cell tumor.
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| ==Classification==
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| *Mediastinal germ cell tumor may be classified according to histopathological subtype in 2 groups:
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| :*Seminoma
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| :*Non-seminomatous germ cell tumours (NSGCT)
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| ::*Embryonal cell carcinoma
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| ::*Choriocarcinoma
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| ::*Yolk sac tumour
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| ::*Teratoma (most common)
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| ::*Mixed germ cell tumor
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| ==Pathophysiology==
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| *The pathogenesis of mediastinal germ cell tumor is characterized by the abnormal migration of germ cells during embryogenesis.
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| *Mediastinal germ cell tumor arises from germ cells, which are normally involved in the formation of o the gametes.
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| *Genetic mutations associated with the development of mediastinal germ cell tumor, include:
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| :*Sex chromosomal abnormalities
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| ::*Loss of 1p, 4q, and 6q
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| ::*Gain of 1q, 3, and 20q
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| *On gross pathology, findings of mediastinal germ cell tumor may include:
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| :*Unencapsulated
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| :*Homogenous fleshy mass with indistinct boundaries
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| :*Invasion of adjacent structures
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| *On microscopic histopathological analysis findings of mediastinal germ cell tumor, include:
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| :*Large tumor cells with clear cytoplasm
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| :*Prominent nucleoli
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| ==Causes==
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| * Mediastinal germ cell tumor may be caused by either [cause1], [cause2], or [cause3].
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| * Mediastinal germ cell tumor is caused by a mutation in the [gene1], [gene2], or [gene3] gene[s].
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| * There are no established causes for mediastinal germ cell tumor.
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| ==Differentiating mediastinal germ cell tumor from other Diseases==
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| *Mediastinal germ cell tumor must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
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| :*[Differential dx1]
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| :*[Differential dx2]
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| :*[Differential dx3]
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| ==Epidemiology and Demographics==
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| * Malignant germ cell tumors of the mediastinum are uncommon
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| * Malignant germ cell tumors represent only 3 to 10% of tumors originating in the mediastinum
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| ===Age===
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| *Patients of all age groups may develop mediastinal germ cell tumor.
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| *Mediastinal germ cell tumor is more commonly observed among patients aged [age range] years old.
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| *Mediastinal germ cell tumor is more commonly observed among [elderly patients/young patients/children].
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| ===Gender===
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| *Mediastinal germ cell tumor affects men and women equally.
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| *[Gender 1] are more commonly affected with mediastinal germ cell tumor than [gender 2].
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| * The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
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| ===Race===
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| *There is no racial predilection for mediastinal germ cell tumor.
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| ==Risk Factors==
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| *Common risk factors in the development of mediastinal germ cell tumor, include:
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| == Natural History, Complications and Prognosis==
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| *The majority of patients with mediastinal germ cell tumor are usually symptomatic at the time of diagnosis
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| *Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
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| *If left untreated, [#%] of patients with mediastinal germ cell tumor may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
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| *The most common complications of mediastinal germ cell tumor is superior vena cava syndrome.
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| *Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with mediastinal germ cell tumor is approximately [#%].
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| == Diagnosis ==
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| ===Diagnostic Criteria===
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| *The diagnosis of mediastinal germ cell tumor is made when at least [number] of the following [number] diagnostic criteria are met:
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| :*[criterion 1]
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| :*[criterion 2]
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| :*[criterion 3]
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| :*[criterion 4]
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| === Symptoms ===
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| *Mediastinal germ cell tumors are usually asymptomatic and found incidentally.
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| *Symptoms of mediastinal germ cell tumor may include the following:
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| :*Chest pain
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| :*Dyspnea
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| :*Cough
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| :*Weight loss
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| :*Superior vena cava syndrome
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| :*Fever
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| :*Nausea
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| === Physical Examination ===
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| *Patients with mediastinal germ cell tumor usually are well-appearing.
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| *Physical examination may be remarkable for:
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| :*Dull percussion
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| :*Tactile fremitus
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| :*Reduced chest expansion
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| :*Crackling or bubbling noises
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| :*Present whispered pectoriloquy
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| === Laboratory Findings ===
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| *Laboratory findings consistent with the diagnosis of mediastinal germ cell tumor, include:
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| :*Elevation in serum alpha-fetoprotein (AFP)
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| :*Elevation in beta-human chorionic gonadotropin (beta-hCG)
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| ===Imaging Findings===
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| *Chest radiography is the initial imaging modality of choice for mediastinal germ cell tumor.
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| *On chest radiography, findings of mediastinal germ cell tumor, include:
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| :*Displaced anterior junction line
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| :*Obliterated cardiophrenic angles
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| :*Obtuse angles with the mediastinum
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| :*Obliterated retrosternal clear space
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| :*Effacement/ dense ascending aorta
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| *On chest radiography, signs of mediastinal germ cell tumor, include:
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| :*'''Hilum Overlay Sign''': hilar vessels through the mass (the mass does not arise from the hilum)
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| *On CT, findings of mediastinal germ cell tumor, include:
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| :*Anterior mediastinal mass
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| :*Obtuse angles with the mediastinum
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| :*Enhancing septations
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| === Other Diagnostic Studies ===
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| *Mediastinal germ cell tumor may also be diagnosed using [diagnostic study name].
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| *Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
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| == Treatment ==
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| === Medical Therapy ===
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| *Cisplatin-based chemotherapy is the treatment of choice for mediastinal germ cell tumors.
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| *Common therapies for mediastinal germ cell tumor, include:
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| :*Etoposide
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| :*Ifosfamide
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| :*Cisplatin
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| :*Bleomycin
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| *Alternative treatment for mediastinal germ cell tumor, include:
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| :*Primary radiotherapy in the absence of metastatic disease
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| === Surgery ===
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| *Surgery is the mainstay of therapy for mediastinal germ cell tumor.
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| * Radical resection in conjunction with chemotherapy/radiation is the most common approach to the treatment of mediastinal germ cell tumor.
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| === Prevention ===
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| *There are no primary preventive measures available for mediastinal germ cell tumor.
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| *Once diagnosed and successfully treated, patients with mediastinal germ cell tumor are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
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| ==References==
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| {{Reflist|2}}
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| [[Category: Oncology]]
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