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Germ cell tumor causing pleural effusion: A diagnostic dilemma
Surabhi Jaggi1, Reetu Kundu2, Sanjeev Binji1
1Junior Resident, Department of Pulmonary Medicine, Government Medical College and Hospital, Sector 32 A, Chandigarh 160030, India.
The Indian Journal of Tuberculosis
|January 16, 2018
Summary
Young adults with unexplained pleural effusion and high adenosine deaminase (ADA) levels may have nonseminomatous germ cell tumors, not just tuberculosis. Thorough clinical exams and biopsies are crucial for accurate diagnosis and avoiding misdiagnosis.
Area of Science:
- Oncology
- Pulmonology
- Pathology
Background:
- Pleural effusion with elevated adenosine deaminase (ADA) in young adults often suggests tuberculosis.
- This can lead to overlooking other serious conditions, potentially delaying critical treatment.
Observation:
- A 35-year-old male presented with pleural effusion, initially treated for tuberculosis based on fluid analysis (lymphocyte-predominant, high ADA).
- Lack of improvement prompted further investigation, revealing a mediastinal mass and hydro-pneumothorax.
- Initial fine needle aspiration cytology (FNAC) reports were conflicting, necessitating a biopsy.
Findings:
- Histopathology confirmed a yolk sac tumor.
- Testicular ultrasound identified a missed left testicular mass.
- Elevated serum lactate dehydrogenase (LDH) and alpha fetoprotein (AFP) supported the diagnosis of nonseminomatous germ cell tumor with mediastinal metastasis.
Implications:
- Highlights the importance of comprehensive physical examinations, even with suggestive initial findings.
- Underscores the potential for misdiagnosis with over-reliance on FNAC, especially in young patients where malignancy can be overlooked.
- Emphasizes the need for a broad differential diagnosis in cases of unexplained pleural effusion unresponsive to initial treatment.
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