Primary malignant germ cell tumours

Study objectives : the aim of this enquiry was to perform a retrospective review on patients treated for primary malignant mediastinal germ cell tumours (PMMGCT) between 1992-2008, to specify their clinical characteristics, their prognostic factors and to evaluate the current therapeutic strategies.Patients: we report a study about 8 patients with seminoma in 3 cases, yolk sac tumour (YST) in 2 cases, embryonal carcinoma (EC) in 1 case, choriocarcinoma in 1 case and teratocarcinoma in 1 case. Pathologic diagnoses were confirmed in all cases by surgical biopsy and a resection of the residual mass in 2 cases.Results: all the patients were male with a mean age of 32 years (range, 16 to 63 years). Only one patient was asymptomatic. The most frequent symptoms were cough (87.5%), chest pain (50%) and dyspnea (50%). The 8 tumours were located in the anterior mediastinum. One patient with EC didn’t received any treatment because of the rapid evolution of the disease. The 7 others received pre-operative chemotherapy and 3 patients received a second-line chemotherapy because of the persistence of viable tumours in one case (YST) and a resistance to the first chemotherapy in 2 cases (seminoma and teratocarcinoma). The overall 2-year survival of patients with seminoma was 100% towards 25% for those with nonseminomatous tumours. The patients with satge I disease survived for a mean period of 3 years.Conclusion: The PMMGCT cause generally a diagnostic challenge because of the difficulty of their resection and the little size of the biopsy specimen. Besides, the absence of a primary gonadal localization may be difficult to establish. These tumours have a worse prognosis than their gonadal counterparts. Prognostic factors are multiple and not accurate. The most relevant ones seem to be the histological type and the disease stage.