Mediastinal germ cell tumors: cohort of patients with this rare entity

Extragonadal germ cell tumors are infrequent and represent between 1-10% of all mediastinal tumors. It presents differences to those of gonadal location in terms of clinical presentation, behavior and prognosis which is poor even with treatment.

Retrospective and descriptive cohort study on 16 patients with diagnosis of mediastinal germ cell tumor surgically treated at Maria Ferrer Respiratory Rehabilitation Hospital and Alexander Fleming Specialized Medical Institute.

Nine men and 7 women were analyzed over a period of 10 years. The median age was significantly lower among men (22 vs. 38 years, P<0.01). The most common initial symptom was pain in 43.75%. Chest tomography was the diagnostic method used in 13 patients (81.25%). Tumor marker levels were raised in 7 patients (43.75%), and decreased after surgery. All women had a mature teratoma, however, no statistically significant difference was found at the histological distribution by gender (P=0.336). The median tumor size was 9.50 centimeters. The most frequent surgical approach was sternotomy. No woman in the series received treatment before or after surgery, while 88.90% of men received neoadjuvant treatment for invasion or intimate contact with neighboring structures (P=0.001). Chemotherapy was indicated in 33.30% of the male population due to relapse. The median follow-up was 36 months (range, 1-95 months). No statistically significant differences were observed in the median follow-up (P=0.950), the percentage of relapses (P=0.091) and overall survival by gender (P=0.335). Overall survival was 75%.

Tumors were predominantly primary and not seminomatous. Multimodal treatment was a useful tool to improve the chances of resection and overall survival. There was a percentage of women higher than the published literature, teratomas predominated in them, and surgery was the only necessary treatment.