IMAGE OF THE WEEK

WEEK 11

  

 

 

ANTERIOR MEDIASTINAL MASS: GERM CELL TUMOUR

 

Mediastinal masses are divided into those that occur in the anterior, middle, and posterior mediastinum. The anterior mediastinum extends from the sternum to the pericardium and brachiocephalic vessels posteriorly. The middle mediastinum lies between the anterior and posterior mediastinum. The posterior mediastinum is bounded by the pericardium and trachea anteriorly and the vertebral column posteriorly.

 

Mediastinal masses are most often identified on chest x-ray or other imaging tests during an examination for chest symptoms or incidentally. Additional diagnostic testing, usually with cross sectional imaging and biopsy, is indicated to determine the aetiology.

 

In adults, thymomas and lymphomas (both Hodgkin and non-Hodgkin) are the most common anterior mediastinal masses. Other causes include; thyroid enlargement, Teratoma, Parathyroid Tumor, and vascular aneurysms.

 

The causes often remembered as the 4Tís:

 

Thyroid

Thymoma

Teratoma

Terrible Lymphoma

 

Germ cell tumors account for approximately 1% of all the malignancies occurring in men, with the testes being the most common site of origin.

Extra gonadal germ cell tumors can occur in the midline of the body from the pineal gland through to the mediastinum, retro peritoneum and sacrum.  Elevated serum alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (HCG) levels may be indicative of malignancy, as these values are within reference ranges in most patients with benign teratomas.    Germ cell tumors are primarily treated with Cisplatin based chemotherapy and the surgical resection is reserved for residual masses.

 

Images prepared by Dr Eddy Ngatemo, Department of Accident & Emergency Medicine, RIPAS Hospital, Brunei Darussalam.

Edited by Dr Ian Bickle.

All images are copyrighted and property of RIPAS Hospital and BIMJonline.

 

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