[Malignant germ cell tumors in the mediastinum]

Mediastinal germ cell tumors are divided into seminomas and non-seminomatous germ cell tumors. The former is a radiosensitive tumor that can be successfully treated by surgery and radiation. The latter is much more malignant than the former, however, the therapy has been making remarkable progress owing to CDDP. Nevertheless, the median survival time of patients with mediastinal involvement is 14 months, much lower than that seen in patients with testicular involvement. From our 12 patients and a review of the literature, we drew the following conclusions. If malignant germ cell tumors are suspected among anterior mediastinal tumors affecting male patients of around 20 years old, tumor markers such as AFP and HCG must be investigated and then, tissue histology should be diagnosed from specimens obtained by mediastinoscopy or anterior mediastinotomy. In the case of NSGCT, or AFP and/or hCG producing seminoma, the first choice is the chemotherapy including CDDP. Seminomas, that do not produce either AFP or HCG, can be treated by surgery and radiation. If the patients have tumor markers such as AFP and/or HCG, these are very useful to evaluate the efficacy of the therapy. When the efficacy of chemotherapy reaches the maximum, adjuvant surgery may be indicated. Chemotherapy should be continued, when malignant tissues are present in the resected mass.