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

BACKGROUND: 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. METHODS: 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. RESULTS: 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%. CONCLUSIONS: 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.