Mediastinal germ cell tumour with massive pulmonary involvement

Area of Science:

• Oncology
• Thoracic Surgery
• Medical Imaging

Background:

• Non-seminomatous germ cell tumors (GCTs) require multimodality treatment.
• Primitive mediastinal GCTs with distant metastases present a therapeutic challenge.

Observation:

• A patient presented with a primitive mediastinal GCT and bilateral lung metastases.
• Treatment involved five cycles of chemotherapy followed by surgical resection.
• Restaging revealed reduced tumor extent, decreased 18-FDG uptake, and normalized beta-hCG levels.

Findings:

• Surgical excision included a mediastinal lesion and 74 lung metastases (35 via right thoracotomy, 39 via left thoracotomy).
• Histological examination of all resected specimens confirmed the absence of viable tumor.
• The patient remained disease-free 12 months post-surgery.

Implications:

• This case demonstrates the efficacy of neoadjuvant chemotherapy followed by radical surgery for advanced mediastinal GCTs.
• Aggressive surgical resection of pulmonary metastases is crucial for achieving cure.
• Successful management highlights the importance of a multidisciplinary approach in treating complex GCT cases.