Mediastinal seminoma: Associated with exophthalmos and gynecomastia

A rare case of mediastinal seminoma associated with exophthalmos and gynecomastia ten years after treatment of testicular seminoma is presented, with a brief review of the literature     

Video-assisted thoracoscopic surgery for a cystic seminoma of the mediastinum

Mediastinal seminomas are uncommon primary mediastinal neoplasms, and most are solid in appearance. Cystic mediastinal seminoma is an unusual type of extragonadal germ cell tumor that has rarely been reported in the literature. Here we describe a 36-year-old man with a 7.5-cm cystic mediastinal seminoma. The tumor was excised successfully by video-assisted thoracoscopic surgery. No recurrence was noted during 28 months of follow-up.     

Successful treatment of mediastinal seminoma with vinblastine, bleomycin, and CIS-platinum

We report on 2 patients with extensive primary mediastinal seminoma treated with vinblastine, bleomycin, and cis-dichlorodiammine platinum who achieved complete remission. These patients are alive forty-six months and sixty-six months without evidence of recurrence of disease. These long-term survivors extend the experience reported previously in the literature. Mediastinal seminoma with extent beyond a rational field of radiation therapy can be treated successfully with chemotherapy.     

Lymphovenous shunting in a case of retroperitoneal seminoma

Lymphovenous shunting in a patient presenting with a metastatic retroperitoneal seminoma is reported. Its aetiology as well as the prognostic value are discussed. A search of the literature has been made and the various theories offered to explain such a phenomonen have been evaluated, in an attempt to corelate them with the findings in our case.     

Seminoma and sarcoidosis: an unusual association

A case is reported of the concurrent presentation of anaplastic seminoma and mediastinal sarcoidosis. This is an exceedingly rare synchronous appearance of both entities and requires meticulous staging prior to initiating definitive therapy.     

Primary mediastinal seminoma

A case of primary mediastinal seminoma in a 25-year-old man is being presented in view of its rarity. The diagnosis was established only after thoracotomy and excision. Further management comprised irradiation and chemotherapy. Possible theories of aetiopathogenesis, clinical profile, staging, and management are discussed along with a brief review of literature.     

Primitive seminoma of the mediastinum: a case report

In this study, the case has been reported of a 36-year old male who was treated at the Ibn Rochd Oncology Center in Casablanca for a primary mediastinal seminoma revealed by a symptomatology including cough, dyspnea, laterocervical swelling, rachidial pain and gait disorder. The preliminary investigation showed significant mediastinal enlargement with a right pleuritis and vertebral metastases; tumor markers were normal. The diagnosis of seminoma was confirmed by pathological and immunohistochemical analysis of the cervical adenopathy. Disease management consisted of BEP/cisplatin type chemotherapy and lumbar, mediastinal, and supraclavicular radiotherapy. The response after four courses of combined chemo-/radiotherapy was estimated at 25%, but the patient died from respiratory failure five months after the initiation of treatment.     

A case of synchronous bilateral spermatocytic seminoma

Bilateral testis tumors are rare and the majority of cases are classic seminoma presenting metachronously. We present the only reported case of synchronous bilateral spermatocytic seminoma.     

Kikuchi–Fujimoto disease masquerading as tuberculosis

Kikuchi–Fujimoto disease (KFD) is a benign, self-limiting subacute necrotizing lymphadenitis with unknown aetiology that has a predilection for young Far East Asian women. It presents with fever, fatigue and lymphadenomegaly and is often misdiagnosed. We report an unusual presentation in a South Asian woman with isolated mediastinal lymphadenopathy masquerading as tuberculosis. There is only one other reported case in the literature presenting with isolated mediastinal lymphadenopathy.     

Large aneurysm of innominate vein: extremely rare cause of mediastinal mass

Aneurysms of the innominate vein are extremely rare. Fifteen such cases have been reported in literature. They may be asymptomatic or may present as a mediastinal mass with compression of adjacent structures or may present with vascular complications like thromboembolism or rupture. We present a case of large innominate vein aneurysm presenting as a mediastinal mass that was surgically excised through a left thoracotomy without use of cardiopulmonary bypass.     

Primary paratesticular seminoma - A case report

INTRODUCTIONParatesticular tumours are rare. Rhabdomyosarcomas are the commonest malignant paratesticular tumours although tumours can arise from any paratesticular structure. Here we report a case of a primary paratesticular seminoma and a review of the literature.PRESENTATION OF CASEA 42 year old man presented with a right scrotal mass. Histology revealed a paratesticular seminoma. Following a radical orchidectomy, there was no evidence of testicular seminoma.DISCUSSIONPrimary paratesticular seminoma in the absence of testicular seminoma is extremely rare.CONCLUSIONAfter a thorough review of the literature, this is, to our knowledge only the second reported case of a primary paratesticular seminoma.     

Aneurysm of the pulmonary artery. Rare long term complication of central aorto-pulmonary shunts for congenital heart disease. Report of two cases with review of the literature

Aneurysm of the left pulmonary artery developed in two patients with tetralogy of Fallot at the site of a Potts' shunt. Although such a complication is known we could not find any previously reported case of successful surgical treatment in the literature. Cardiac catheterization and angiography provided the definitive diagnosis. One patient refused surgical intervention but later presented with fatal rupture and massive hemoptysis. Closure of the Potts' shunt, angioplastic repair of the pulmonary artery aneurysm and total correction of tetralogy of Fallot were successfully accomplished using cardiopulmonary bypass and cardioplegic arrest. Aneurysm should be suspected whenever a mediastinal mass appears in patients with a previous systemic-pulmonary artery shunt.     

Primary mediastinal seminoma

Three new cases of primary mediastinal seminoma are presented, and 124 other cases in the literature are reviewed. These tumors primarily affect white males in the third decade. Chest pain is the most common symptom, but 20 per cent of the patients can be asymptomatic. Testicular atrophy occurred in only 7 patients. In one of these a testicular seminoma developed seven years after treatment of a primary mediastinal tumor. Supraclavicular adenopathies were found in 10 patients. Chest x-ray films typically show an anterior mediastinal noncalcified mass with smooth lobulated borders. Twenty-eight of 74 surgical resections attempted were successful; 13 of these received adjuvant irradiation. Of 64 cases in which radiation therapy was the primary mode of treatment, local failures occurred only in 7 cases. These tumors spread primarily by distant metastases. Theories of tumoral origin and patterns of spread are discussed. A dose of 3,000 rad in three weeks and 4,500 rad in four and one-half weeks to the mediastinum and supraclavicular areas is recommended for minimal and bulky disease. Primary mediastinal seminoma is as radiosensitive as its testicular counterpart.     

Primary mediastinal seminoma: a comprehensive assessment integrated with histology, immunohistochemistry, and fluorescence in situ hybridization for chromosome 12p abnormalities in 23 cases

Accurate diagnosis of mediastinal seminoma is critical because of its favorable response to radiation therapy and/or cisplatin-based chemotherapy. Immunohistochemical staining for OCT4 has recently been validated as a powerful tool for detecting gonadal seminoma. However, discrepancies between the genetic alterations and immunoprofiles of mediastinal and testicular seminomas have been reported, raising the question of whether techniques that are useful in the diagnosis of gonadal seminoma are applicable to its mediastinal counterpart. The present study was conducted to evaluate the morphologic and immunohistochemical characteristics and chromosomal abnormalities of 12p in 23 primary mediastinal seminomas and to compare their applicability as diagnostic tools. Dual-color fluorescence in situ hybridization (FISH) analyses for chromosome 12p and immunostains for OCT4, c-kit, placental-like alkaline phosphatase, CD30, and a panel of cytokeratins, including cytokeratin AE1/AE3 (AE1/3), high molecular weight cytokeratin (34betaE12, HMWCK), CAM5.2, cytokeratin 7 (CK7), cytokeratin 20 (CK20), and epithelial membrane antigen were performed. Lymphocytic infiltration was found in all 23 cases (100%). The incidence of other histologic characteristics were as follows: fibrous septa/stroma (21 cases, 91%), prominent tumor cell nucleoli (21 cases, 91%), clear tumor cell cytoplasm (20 cases, 87%), distinct tumor cell borders (20 cases, 87%), granulomatous inflammation (17 cases, 74%), cellular pleomorphism (10 cases, 43%), necrosis (8 cases, 35%), prominent cystic change (2 cases, 8%), intercellular edema (1 case, 4%), and syncytiotrophoblasts (1 case, 4%). The mean mitotic count was 4.4 (range 0 to 16) per 10 high-power fields. Moderate to strong nuclear OCT4 staining was identified in all 23 cases (100%). Seventeen tumors (74%) showed membranous expression of c-kit, with variable staining intensity and percentages. Weakly to moderately intense immunostaining for placental-like alkaline phosphatase was identified in 10 cases (43%) with occasional background staining artifact. The incidences of positive staining were 43% for AE1/3, 39% for HMWCK, 48% for CAM5.2, 39% for CK7, and 9% for epithelial membrane antigen, respectively. In most cases, these epithelial markers highlighted only a small proportion of tumor cells with variable intensities. Immunostaining for CD30 and CK20 was completely negative in all seminomas. Twenty-two seminomas (96%) revealed chromosome 12p abnormalities, including 12p amplification in 20 cases (87%) or i(12p) in 15 cases (65%). Lymphocytic infiltration is the most common histologic feature observed in primary mediastinal seminoma and both OCT4 immunostain and FISH for 12p abnormalities can be very helpful in diagnosing mediastinal seminoma. The intense staining pattern of OCT4 and the high sensitivity of FISH make them superior to other auxiliary diagnostic utilities for detecting seminoma. In addition, the incidences of cytokeratin expression of primary mediastinal seminoma are similar to those of its gonadal counterpart and pathologists must exercise caution in the interpretation of epithelial markers in mediastinal neoplasms.     

Case of mediastinal seminoma with testicular microlithiasis

Testicular microlithiasis is a rare condition in which calcified concretions fill the lumina of the seminiferous tubules. We report the case of a 19-year-old Japanese man with mediastinal seminoma, normal testicular physical findings and bilateral testicular microlithiasis seen on ultrasonography. Testicular needle biopsy demonstrated multiple laminated calcifications within the seminiferous tubules without any signals of a viable germ cell tumor. To our knowledge, this is only the sixth reported case of extragonadal germ cell tumor with testicular microlithiasis.     

A case of bilateral testicular germ cell tumor

A case of bilateral successive tumor of germ cell origin is reported. A 29-year-old man visited our clinic with a complaint of swelling of right scrotal contents 18 months after initial left orchiectomy for a seminoma. The right orchiectomy was performed and its histological finding was also seminoma. Between 1965-1987 we treated 55 patients with testicular germ cell tumors. Two of them suffered a second germ cell tumor. One of them who had different histology of teratocarcinoma on left side and seminoma on right side had been reported previously. Herein, we report the second case and review the literature.     

Spontaneous regression of anterior mediastinal seminoma with normalization of β-human chorionic gonadotropin levels

IntroductionAlthough spontaneous regression (SR) of anterior mediastinal seminoma is very rare with normalization of β-human chorionic gonadotropin (β-hCG) level, video-assisted thoracic surgery (VATS) is the most effective solution for definite diagnosis of indeterminate anterior mediastinal masses.Diagnosis, therapeutic interventions, and outcomesA rare case of an asymptomatic 37-year-old man with an anterior mediastinal mass that was detected on a routine chest X-ray is presented. Computed tomography (CT) showed a large anterior mediastinal tumor with superior vena cava invasion and SR before VATS for definitive diagnosis. On pathology, the definitive diagnosis was seminoma. Microscopic examination showed abundant apoptotic cells within the tumor. Chemotherapy (bleomycin 30 mg/day, etoposide 200 mg/day, cisplatin 40 mg/day) was given to this patient, and the tumor showed high sensitivity.ConclusionAnterior mediastinal seminoma showing SR induced by spontaneous apoptosis of tumor cells may have good sensitivity to chemotherapy, and a good clinical outcome may be achieved in these patients. This case also highlights that VATS is the most effective solution for definite diagnosis of indeterminate anterior mediastinal masses.     

Late recurrence of a seminoma

We report a case of an extragonadal mediastinal seminoma that recurred almost 19 years after successful initial remission had been achieved with actinomycin D and chlorambucil. Treatment of the recurrence consisted of excision of a single involved supraclavicular lymph node followed by combination chemotherapy with cis-platinum, vinblastine and bleomycin. The patient has remained free of residual disease for 3 years. To our knowledge this case represents the longest reported interval to recurrence for a germ cell neoplasm.     

Mediastinal cyst containing mural pancreatic tissue.

The second documented case of mediastinal ectopic tissue presenting as a mediastinal mass is reported. Previously reported cases of ectopic pancreatic tissue in the thorax are reviewed in an attempt to explain this anomalous development.     

Successful resection of mediastinal seminoma evaluated the response to induction chemotherapy with fluorodeoxyglucose-positron emission tomography

Mediastinal seminoma is a rare malignant tumor, and the current strategy for primary mediastinal seminomas is making a prompt diagnosis and achieving an appropriate chemotherapy. However, consensus regarding the optimal post-chemotherapy management has not been reached. We experienced a case of 26-year-old man who was diagnosed mediastinal seminoma and evaluated the response to induction chemotherapy with fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT). Complete surgical excision of the tumor was performed. Pathologic findings of the surgical specimen showed no viable cells in the tumor.