Mediastinal germ cell tumor: Difference between revisions

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#REDIRECT [[Mediastinal mass differential diagnosis]]
{{SI}}                                                                 
{{CMG}} {{AE}} {{MV}}
{{SK}} M-GCTs;
==Overview==
 
'''Mediastinal germ cell tumor''' is a extragonadal [[tumor]] derived from [[germ cell]] remnants in the [[mediastinum]] and a cause of anterior mediastinal mass.<ref >{{Cite journal | author = Alan Sandler| year = 1997 | url = https://www.thieme-connect.com/ejournals/abstract/10.1055/s-2007-1009353 | title = Mediastinal Germ Cell Tumors| journal = Semin Respir Crit Care Med| volume = 18| issue=4 | page = 383-392 | doi=10.1055/s-2007-1009353}}</ref><ref>{{Cite web|url=http://emedicine.medscape.com/article/359110-overview| title=Mediastinal Germ Cell Tumor Imaging }}</ref> Malignant germ cell tumors of the mediastinum are uncommon, representing only 3 to 10% of tumors originating in the mediastinum.
 
==Historical Perspective==
*Mediastinal germ cell tumor was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*In [year], [gene] mutations were first identified in the pathogenesis of mediastinal germ cell tumor.
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose mediastinal germ cell tumor.
==Classification==
*Mediastinal germ cell tumor may be classified according to histopathological subtype in 2 groups:
:*Seminoma
:*Non-seminomatous germ cell tumours (NSGCT)
::*Embryonal cell carcinoma
::*Choriocarcinoma
::*Yolk sac tumour
::*Teratoma (most common)
::*Mixed germ cell tumor
==Pathophysiology==
*The pathogenesis of mediastinal germ cell tumor is characterized by the abnormal migration of germ cells during embryogenesis.
*Mediastinal germ cell tumor arises from germ cells, which are normally involved in the formation of o the gametes.
*Genetic mutations associated with the development of mediastinal germ cell tumor, include:
:*Sex chromosomal abnormalities
::*Loss of 1p, 4q, and 6q
::*Gain of 1q, 3, and 20q
*On gross pathology,  findings of mediastinal germ cell tumor may include:
:*Unencapsulated
:*Homogenous fleshy mass with indistinct boundaries
:*Invasion of adjacent structures
*On microscopic histopathological analysis  findings of mediastinal germ cell tumor, include:
:*Large tumor cells with clear cytoplasm
:*Prominent nucleoli
 
==Causes==
* Mediastinal germ cell tumor may be caused by either [cause1], [cause2], or [cause3].
* Mediastinal germ cell tumor is caused by a mutation in the [gene1], [gene2], or [gene3] gene[s].
* There are no established causes for mediastinal germ cell tumor.
==Differentiating mediastinal germ cell tumor from other Diseases==
*Mediastinal germ cell tumor must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
:*[Differential dx1]
:*[Differential dx2]
:*[Differential dx3]
==Epidemiology and Demographics==
* Malignant germ cell tumors of the mediastinum are uncommon
* Malignant germ cell tumors represent only 3 to 10% of tumors originating in the mediastinum
 
===Age===
*Patients of all age groups may develop mediastinal germ cell tumor.
*Mediastinal germ cell tumor is more commonly observed among patients aged [age range] years old.
*Mediastinal germ cell tumor is more commonly observed among [elderly patients/young patients/children].
===Gender===
*Mediastinal germ cell tumor affects men and women equally.
*[Gender 1] are more commonly affected with mediastinal germ cell tumor than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
===Race===
*There is no racial predilection for mediastinal germ cell tumor.
==Risk Factors==
*Common risk factors in the development of mediastinal germ cell tumor, include:
 
== Natural History, Complications and Prognosis==
*The majority of patients with mediastinal germ cell tumor are usually symptomatic at the time of diagnosis
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with mediastinal germ cell tumor may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*The most common complications of mediastinal germ cell tumor is superior vena cava syndrome.
*Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with mediastinal germ cell tumor is approximately [#%].
== Diagnosis ==
===Diagnostic Criteria===
*The diagnosis of mediastinal germ cell tumor is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 2]
:*[criterion 3]
:*[criterion 4]
=== Symptoms ===
*Mediastinal germ cell tumors are usually asymptomatic and found incidentally.
*Symptoms of mediastinal germ cell tumor may include the following:
:*Chest pain
:*Dyspnea
:*Cough
:*Weight loss
:*Superior vena cava syndrome
:*Fever
:*Nausea
=== Physical Examination ===
*Patients with mediastinal germ cell tumor usually are well-appearing.
*Physical examination may be remarkable for:
:*Dull percussion
:*Tactile fremitus
:*Reduced chest expansion
:*Crackling or bubbling noises
:*Present whispered pectoriloquy
 
=== Laboratory Findings ===
*Laboratory findings consistent with the diagnosis of mediastinal germ cell tumor, include:
:*Elevation in serum alpha-fetoprotein (AFP)
:*Elevation in beta-human chorionic gonadotropin (beta-hCG)
 
===Imaging Findings===
*Chest radiography is the initial imaging modality of choice for mediastinal germ cell tumor.
*On chest radiography, findings of mediastinal germ cell tumor, include:
:*Displaced anterior junction line
:*Obliterated cardiophrenic angles
:*Obtuse angles with the mediastinum
:*Obliterated retrosternal clear space
:*Effacement/ dense ascending aorta
*On chest radiography, signs of mediastinal germ cell tumor, include:
:*'''Hilum Overlay Sign''': hilar vessels through the mass (the mass does not arise from the hilum)
*On CT, findings of mediastinal germ cell tumor, include:
:*Anterior mediastinal mass
:*Obtuse angles with the mediastinum
:*Enhancing septations
 
=== Other Diagnostic Studies ===
*Mediastinal germ cell tumor may also be diagnosed using [diagnostic study name].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
== Treatment ==
=== Medical Therapy ===
*Cisplatin-based chemotherapy is the treatment of choice for mediastinal germ cell tumors.
*Common therapies for mediastinal germ cell tumor, include:
:*Etoposide
:*Ifosfamide
:*Cisplatin
:*Bleomycin
*Alternative treatment for mediastinal germ cell tumor, include:
:*Primary radiotherapy in the absence of metastatic disease
 
=== Surgery ===
*Surgery is the mainstay of therapy for mediastinal germ cell tumor.
* Radical resection in conjunction with chemotherapy/radiation is the most common approach to the treatment of mediastinal germ cell tumor.
 
=== Prevention ===
*There are no primary preventive measures available for mediastinal germ cell tumor.
*Once diagnosed and successfully treated, patients with mediastinal germ cell tumor are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
 
==References==
{{Reflist|2}}
[[Category: Oncology]]

Latest revision as of 17:25, 19 February 2019