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{{SI}}
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{{Mediastinal germ cell tumor}}
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{{CMG}}
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==Overview==
[[Malignant]] '''mediastinal germ cell tumors''' of various histologies were first described as a clinical entity approximately 50 years ago. [[mediastinum|Mediastinal]] and other extragonadal [[germ cell tumors]] were initially thought to represent isolated [[metastasis|metastases]] from an inapparent gonadal primary site.


==Epidemiology and Demographics==
==[[Mediastinal germ cell tumor overview|Overview]]==
Malignant germ cell tumors of the mediastinum are uncommon, representing only 3 to 10% of tumors originating in the mediastinum. They are much less common than germ cell tumors arising in the [[testes]], and account for only 1 to 5% of all germ cell [[neoplasm]]s.
 
==[[Mediastinal germ cell tumor historical perspective|Historical Perspective]]==
 
==[[Mediastinal germ cell tumor pathophysiology|Pathophysiology]]==


==Pathophysiology==
==[[Mediastinal germ cell tumor epidemiology and demographics|Epidemiology & Demographics]]==
Some investigators suggest that this distribution arises as a consequence of abnormal migration of germ cells during embryogenesis. 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.


'''Associated Syndromes'''
==[[Mediastinal germ cell tumor risk factors|Risk Factors]]==
* [[Klinefelter's syndrome]]
* Hematologic Neoplasia


==Diganosis==
==[[Mediastinal germ cell tumor screening|Screening]]==
===Symptoms===
Unlike benign germ cell tumors of the mediastinum, malignant mediastinal tumors are usually symptomatic at the time of diagnosis. Most mediastinal malignant tumors are large and cause symptoms by compressing or invading adjacent structures, including the lungs, pleura, pericardium, and chest wall.


[[Seminoma]]s grow relatively slowly and can become very large before causing symptoms. Tumors 20 to 30 cm in diameter can exist with minimal symptomatology.
==[[Mediastinal germ cell tumor causes|Causes of Mediastinal germ cell tumor]]==


===Staging===
==[[Mediastinal germ cell tumor differential diagnosis|Differentiating Mediastinal germ cell tumor from other Diseases]]==
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]] ([[AFP]])


<div align="left">
==[[Mediastinal germ cell tumor natural history|Natural History, Complications & Prognosis]]==
<gallery heights="175" widths="175">
Image:Germ-cell-tumor-001.jpg|CT shows [[Mediastinal germ cell tumor | Mediastinal Teratoma]]  
Image:Germ-cell-tumor-002.jpg|CT shows [[Mediastinal germ cell tumor | Mediastinal Teratoma]]
</gallery>
</div>


==Treatment ==
==[[Mediastinal germ cell tumor staging|Staging]]==
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, and selection of treatment therefore depends on disease stage and size of mediastinal tumor.


In summary, most patients with mediastinal seminoma can be cured with therapy, and all patients should be approached with this intent. Patients with small tumors (usually asymptomatic) that appear resectable should undergo thoracotomy and attempted complete resection.
==Diagnosis==
[[Mediastinal germ cell tumor history and symptoms|History & Symptoms]] | [[Mediastinal germ cell tumor physical examination|Physical Examination]] | [[Mediastinal germ cell tumor laboratory tests|Lab Tests]] | [[Mediastinal germ cell tumor electrocardiogram|Electrocardiogram]] | [[Mediastinal germ cell tumor chest x ray|Chest X Ray]] | [[Mediastinal germ cell tumor CT|CT]] | [[Mediastinal germ cell tumor MRI|MRI]] | [[Mediastinal germ cell tumor echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Mediastinal germ cell tumor other imaging findings|Other Imaging Findings]] | [[Mediastinal germ cell tumor other diagnostic studies|Other Diagnostic Studies]]


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 is considered standard therapy.
==Treatment==
[[Mediastinal germ cell tumor medical therapy|Medical Therapy]] | [[Mediastinal germ cell tumor surgery|Surgery]] | [[Mediastinal germ cell tumor primary prevention|Primary Prevention]] | [[Mediastinal germ cell tumor secondary prevention|Secondary Prevention]] | [[Mediastinal germ cell tumor cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Mediastinal germ cell tumor future or investigational therapies|Future or Investigational Therapies]]


==Sources==
==Sources==
#Primary Germ Cell Tumors of the Thorax [http://www.health.am/cr/malignant-germ-cell-tumors/ Malignant Mediastinal Germ Cell Tumors]
#Primary Germ Cell Tumors of the Thorax [http://www.health.am/cr/malignant-germ-cell-tumors/ Malignant Mediastinal Germ Cell Tumors]
#Knapp RH, Hurt RD, Payne WS, et al. Malignant germ cell tumors of the mediastinum. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&amp;cmd=Search&amp;defaultField=Title+Word&amp;term=J+Thorac+Cardiovasc+Surg%5Bjour%5D+AND+89%5Bvolume%5D+AND+82%5Bpage%5D+AND+1985%5Bpdat%5D+AND+Knapp+RH%5Bauth%5D J Thorac Cardiovasc Surg 1985;89:82-9]
#Knapp RH, Hurt RD, Payne WS, et al. Malignant germ cell tumors of the mediastinum. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&amp;cmd=Search&amp;defaultField=Title+Word&amp;term=J+Thorac+Cardiovasc+Surg%5Bjour%5D+AND+89%5Bvolume%5D+AND+82%5Bpage%5D+AND+1985%5Bpdat%5D+AND+Knapp+RH%5Bauth%5D J Thorac Cardiovasc Surg 1985;89:82-9]
==References==
#Vugrin D, Martini N, Whitmore WF, Goldberg RB. VAB-3 combination chemotherapy in primary mediastinal germ cell tumors. Cancer Treat Rep 1982;66:1405-7.
#Einhorn L, Williams S, Loehrer P, et al. Phase III study of cisplatin dose intensity in advanced germ cell tumors. A Southeastern and Southwest Oncology Group protocol. Proc Am Soc Clin Oncol 1990;9:132.
#Moran CA, Suster S. Primary germ cell tumors of the mediastinum - I. Analysis of 322 cases with special emphasis on teratomatous lesions and a proposal for histopathologic classification and clinical staging. Cancer 1997:80:681-90.


==See also ==
==See also ==
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* [[Mediastinal fibrosis]]
* [[Mediastinal fibrosis]]
* [[Mediastinum]]
* [[Mediastinum]]
{{SIB}}


[[Category:Thorax]]
[[Category:Thorax]]

Revision as of 16:02, 20 January 2012

Template:Mediastinal germ cell tumor Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Historical Perspective

Pathophysiology

Epidemiology & Demographics

Risk Factors

Screening

Causes of Mediastinal germ cell tumor

Differentiating Mediastinal germ cell tumor from other Diseases

Natural History, Complications & Prognosis

Staging

Diagnosis

History & Symptoms | Physical Examination | Lab Tests | Electrocardiogram | Chest X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Sources

  1. Primary Germ Cell Tumors of the Thorax Malignant Mediastinal Germ Cell Tumors
  2. Knapp RH, Hurt RD, Payne WS, et al. Malignant germ cell tumors of the mediastinum. J Thorac Cardiovasc Surg 1985;89:82-9

See also


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