Mediastinal germ cell tumors. Surgical experience with twenty nine patients

Abstract

Background: To review and inform about the experience acquired with management of germ cell tumors of the mediastinum at the Calderón Guardia Hospital.Methods: Twenty-nine patients with mediastinal germ cell tumors were operated between 1986 and 2012 in the Thoracic Surgery Department. General information was obtained from the department s database and these patients' clinical files were reviewed with authorization from the Hospital's Ethics Committee.Results: Subjects were predominantly young males with a gender ratio of 13.5:1 and a mean age of 26. Masses were located in the anterior mediastinum in 28 cases and in the middle mediastinum in 1 case. Twenty-seven cases were suspected due tomediastinal widening on chest x-ray examination, 1 to pleural effusion and 1 to pleural effusion and mediastinal widening. The most frequently found symptoms were dyspnea, retrosternal chest pain, fever, cough, weight loss, superior vena cava syndrome, hemoptysis and gynecomastia in one male with coriocarcinoma. Tissue for diagnosis was obtained in 14 cases by mediastinotomy, in 8 by thoracotomy, in 4 by video assisted thoracoscopy, in 1 by sternotomy, in 1 by mediastinoscopy and in 1 by bronchoscopy.Conclusion: Germ cell tumors of the mediastinum are infrequent, with higher prevalence in young males. Complete surgical excision remains the treatment of choice for resectable tumors, which are usually of more benign histology. Cure is not guaranteed by apparent total resection of malignant germ cell tumors, therefore primary or adjuvant chemotherapy should always be considered given that it was curative for some partially resected tumors and others with apparent total resection recidivated.