Mediastinal germ cell tumor: Difference between revisions

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== Treatment ==
== Treatment ==
=== Medical Therapy ===
=== Medical Therapy ===
*The mainstay of therapies for mediastinal germ cell tumor, include:
*Cisplatin-based chemotherapy is the treatment of choice for mediastinal germ cell tumors.
*Common therapies for mediastinal germ cell tumor, include:
:*Etoposide
:*Etoposide
:*Ifosfamide
:*Ifosfamide
:*Cisplatin
:*Cisplatin
:*Bleomycin
:*Bleomycin
 
=== Surgery ===
=== Surgery ===
*Surgery is the mainstay of therapy for mediastinal germ cell tumor.
*Surgery is the mainstay of therapy for mediastinal germ cell tumor.

Revision as of 13:53, 14 April 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Synonyms and keywords: Synonym 1; Synonym 2; Synonym 3

Overview

Mediastinal germ cell tumor is a extragonadal tumor derived from germ cell remnants in the mediastinum and a cause of anterior mediastinal mass.[1] [2] 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.
  • The [gene name] gene/Mutation in [gene name] has been associated with the development of mediastinal germ cell tumor, involving the [molecular pathway] pathway.
  • On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of mediastinal germ cell tumor.
  • On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of mediastinal germ cell tumor.

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:
  • [finding 1]
  • [finding 2]
  • [finding 3]
  • [finding 4]
  • [finding 5]
  • [finding 6]

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

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

  1. Alan Sandler (1997). "Mediastinal Germ Cell Tumors". Semin Respir Crit Care Med. 18 (4): 383-392. doi:10.1055/s-2007-1009353.
  2. "Mediastinal Germ Cell Tumor Imaging".