[Primary malignant mediastinal germ cell tumor causing pericardial effusion]

A 19-year-old man presented with chest pain, dyspnea and dry cough. Chest X-ray and computerized tomography showed a large, anterior, mediastinal mass. 2-dimensional echocardiography demonstrated a large amount of pericardial fluid. Serum alpha-fetoprotein was increased. Fine-needle, aspiration cytology during anterior mediastinotomy revealed malignant cells. Anterior thoracotomy demonstrated a large, anterior, mediastinal mass extending into the pericardial sac. The tumor was incompletely resected and 700 ml of pericardial fluid were removed. Histological examination showed a malignant, mixed, germ cell tumor. Cytologic examination of pericardial fluid revealed malignant tumor cells. Postoperatively, combined chemotherapy was administered and 3 years later the patient is free of symptoms.