[Primary germinal tumor of the mediastinum: study of a case evolving over 7 years]

Mediastinal seminoma is a rare malignant germ cell neoplasm histologically identical to the more common gonadal germinoma. The case reported here illustrates typical findings for presentation and response to primary therapy in mediastinal seminoma. The tumor was located in the anterior mediastinum and appeared as a well-defined lobulated mass. However, the patient's subsequent course was unusual in the multiplicity of sites of disseminated disease, and in that all were apparently controlled by local irradiation and chemotherapy. Primary treatment used was surgery and radiotherapy of the mediastinum. The patient developed bony metastases 2 years after, and these lesions were treated with radiotherapy followed by chemotherapy. Four years after, a new mediastinal mass began to enlarge with metastases in the lungs and the bone. This recurrence was controlled by chemotherapy only. Mediastinal germ cell tumors is thought by some observers to represent related aberrations of embryologic development with subsequent malignant changes. These tumors usually occur in young men and most patients are symptomatic (dyspnea), but some others present without symptoms and are diagnosed from a routine chest X-ray. The relatively high proportion of lungs and bony metastases may reflect an increased tendency to vascular spread from the great vessels. Combination chemotherapy with cis-platinum, bleomycin and vinblastine will induce complete remission in 70% of patients with disseminated germ cell tumors. New active agents such as VP-16 and carboplatin appear to be the most active drugs next cis-platinum for these tumors.