The occurrence of sarcomatous components in primary mediastinal germ cell tumors

The occurrence of a sarcomatous component in germ cell tumors is an uncommon phenomenon; seven cases with such an association are presented. The sarcomatous elements were rhabdomyosarcomatous in four cases, angiosarcomatous in two, and a combination of these two types in one case. Immunohistochemical studies supported the endothelial and skeletal muscle differentiation of the sarcomatous components. All patients were treated surgically, and some received various chemotherapeutic agents and radiation. On follow-up, four patients had died of their disease, one developed recurrence and pulmonary metastases, one was free of disease after 4 years, and one is a recent case. Chemotherapy protocols may need to be altered to include sarcoma-oriented drugs for this particular group of patients.