Mediastinal endodermal sinus tumour: surgical role in chemotherapy resistant cases

We report two cases of aggressive mediastinal endodermal sinus tumours (EST) detected incidentally on a chest radiograph. The patients were being investigated for minor chest complaints. After three courses of cisplatin-based chemotherapy the tumour marker levels declined. However, the tumour size continued to increase. Complete surgical removal was possible in one case and significant reduction in tumour mass was achieved in the other. Reduction in the viable, tumour tissue load made the residual tumour sensitive to postoperative chemotherapy. It is important to be aware of endodermal sinus tumours refractory to chemotherapy which may require early surgical intervention.