{"entity":{"id":"mediastinal-germ-cell-tumour","kind":"cancer","name":"Mediastinal germ cell tumour","aka":["Primary mediastinal germ cell tumour","Mediastinal seminoma","Primary mediastinal non-seminomatous germ cell tumour","PMNSGCT","Mediastinal teratoma"],"tldr":"A mediastinal germ cell tumour is a germ cell tumour that starts in the chest, between the lungs, rather than in the testis. Seminomas here are cured almost as often as testicular seminoma, but non-seminomas of the chest are the hardest germ cell tumours to cure, so they get four cycles of chemotherapy and surgery for what is left.","summary":"Germ cell tumours of the mediastinum arise in the anterior mediastinum, in or beside the thymus, from germ cells that stayed behind in the midline during development. The WHO classification of tumours of the thymus and mediastinum (5th edition, 2021) lists them with the same histological types as testicular disease: seminoma, embryonal carcinoma, yolk sac tumour, choriocarcinoma, teratoma (mature and immature) and mixed tumours, plus germ cell tumours with somatic-type malignancy or an associated haematological malignancy (Marx 2022). Diagnosis rests on imaging, the serum markers alpha-fetoprotein and beta-hCG, and biopsy where the markers are not raised.\n\nHow it differs from its parent: site decides the outlook. In the pooled analysis of 635 extragonadal germ cell tumours, 49 percent of patients with mediastinal non-seminoma were alive after platinum chemotherapy with or without surgery, against 63 percent with retroperitoneal non-seminoma, while seminoma had an 88 percent overall survival whatever the site (Bokemeyer 2002). A mediastinal non-seminomatous primary alone places a patient in the poor-risk group of the International Germ Cell Cancer Collaborative Group classification (Rosti 2019). Haematological malignancies (17 cases, above all acute leukaemias) occurred only in the 287 patients with mediastinal non-seminoma, an incidence of 2.0 percent a year and a standardised incidence ratio of 250 against the general population; none of those 17 survived two years (Hartmann 2000).\n\nHow common: no incidence figure is published for the mediastinal site alone; the parent page gives the share of germ cell tumours that arise outside the gonads.\n\nTreatment follows the parent's poor-risk pathway: four cycles of cisplatin-based chemotherapy (BEP or VIP), then resection of residual disease (NCI PDQ; EAU and ESMO testicular guidance as cited on the parent page). Surgery after chemotherapy is major: in 158 patients operated on over 25 years at Indiana, mean age 29, operative mortality was 6 percent, nine of the ten deaths from respiratory failure (Kesler 2008). Relapse is treated with the salvage regimens tested in the TIGER trial, which names primary mediastinal non-seminoma among its poorest-risk entrants.","asOf":"2026-09-24","wikipedia":"https://en.wikipedia.org/wiki/Germ_cell_tumor","links":[{"label":"NCI PDQ: extragonadal germ cell tumours treatment","url":"https://www.cancer.gov/types/extragonadal-germ-cell/patient/extragonadal-treatment-pdq"},{"label":"WHO Classification of Tumours of the thymus and mediastinum, 5th edition (Marx 2022, JTO summary)","url":"https://doi.org/10.1016/j.jtho.2021.10.010"},{"label":"Bokemeyer 2002, JCO: extragonadal germ cell tumours of the mediastinum and retroperitoneum, 635 patients","url":"https://doi.org/10.1200/jco.2002.07.062"},{"label":"Hartmann 2000, JNCI: haematological disorders with primary mediastinal non-seminomatous germ cell tumours","url":"https://doi.org/10.1093/jnci/92.1.54"},{"label":"Kesler 2008, Ann Thorac Surg: 25 years of surgery for primary mediastinal non-seminomatous germ cell tumours","url":"https://doi.org/10.1016/j.athoracsur.2007.09.020"},{"label":"Rosti 2019, Seminars in Oncology: primary mediastinal germ cell tumours (review)","url":"https://doi.org/10.1053/j.seminoncol.2019.04.001"}],"tags":["subtype-page","wave4","rare"],"related":["extragonadal-germ-cell-tumour","retroperitoneal-germ-cell-tumour","cns-germ-cell-tumours","non-seminoma","seminoma","thymic-epithelial","hyperparathyroidism-jaw-tumour-syndrome"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":["bleomycin","etoposide","cisplatin","ifosfamide"],"companies":[],"institutions":[],"pathways":[],"terms":["afp","tumour-markers","autologous-transplant"],"trials":["tiger-trial"],"people":[],"bottlenecks":[],"keyPapers":["paper-who-2021-thymus-mediastinum-classification-marx-jto-2022"],"journals":[],"dependsOn":[],"notes":[],"group":"genitourinary","burden":"Rare and not counted separately by GLOBOCAN. In the international analysis of 635 extragonadal germ cell tumours treated at 11 centres from 1975 to 1996, 341 (54 percent) arose in the mediastinum; 83 percent of the whole series were non-seminomas (Bokemeyer 2002).","subtypes":["Mediastinal seminoma","Mediastinal non-seminomatous germ cell tumour (embryonal carcinoma, yolk sac tumour, choriocarcinoma, mixed)","Mediastinal teratoma (mature and immature)","Germ cell tumour with associated haematological malignancy"],"biomarkers":["Alpha-fetoprotein and beta-hCG at diagnosis and after each cycle","Lactate dehydrogenase","Isochromosome 12p on the biopsy","Blood count during follow-up, for the leukaemia risk in non-seminoma"],"standardOfCare":[{"setting":"Mediastinal seminoma","approach":"Treated as extragonadal seminoma: cisplatin-based chemotherapy, with PET to judge residual masses.","refs":["extragonadal-germ-cell-tumour","cisplatin","etoposide"]},{"setting":"Mediastinal non-seminoma","approach":"Four cycles of BEP or VIP, then resection of residual disease in a centre that does this surgery often; salvage as in the TIGER trial.","refs":["extragonadal-germ-cell-tumour","bleomycin","etoposide","cisplatin","ifosfamide","tiger-trial"]}],"stateOfArt":[],"history":[],"pipeline":[],"openProblems":[],"parent":"extragonadal-germ-cell-tumour"},"route":"/cancers/mediastinal-germ-cell-tumour/","neighbours":{"cancer":[{"id":"cns-germ-cell-tumours","kind":"cancer","name":"Central nervous system germ cell tumours (germinoma and non-germinomatous)","route":"/cancers/cns-germ-cell-tumours/"},{"id":"testicular-choriocarcinoma","kind":"cancer","name":"Choriocarcinoma of the testis","route":"/cancers/testicular-choriocarcinoma/"},{"id":"extragonadal-germ-cell-tumour","kind":"cancer","name":"Extragonadal germ cell tumour","route":"/cancers/extragonadal-germ-cell-tumour/"},{"id":"hyperparathyroidism-jaw-tumour-syndrome","kind":"cancer","name":"Hyperparathyroidism-jaw tumour syndrome (CDC73-related parathyroid carcinoma)","route":"/cancers/hyperparathyroidism-jaw-tumour-syndrome/"},{"id":"non-seminoma","kind":"cancer","name":"Non-seminomatous germ cell tumour","route":"/cancers/non-seminoma/"},{"id":"retroperitoneal-germ-cell-tumour","kind":"cancer","name":"Retroperitoneal germ cell tumour","route":"/cancers/retroperitoneal-germ-cell-tumour/"},{"id":"seminoma","kind":"cancer","name":"Seminoma","route":"/cancers/seminoma/"},{"id":"thymic-epithelial","kind":"cancer","name":"Thymoma and thymic carcinoma","route":"/cancers/thymic-epithelial/"}],"drug":[{"id":"bleomycin","kind":"drug","name":"Bleomycin","route":"/drugs/bleomycin/"},{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"},{"id":"etoposide","kind":"drug","name":"Etoposide","route":"/drugs/etoposide/"},{"id":"ifosfamide","kind":"drug","name":"Ifosfamide","route":"/drugs/ifosfamide/"}],"term":[{"id":"afp","kind":"term","name":"Alpha-fetoprotein (AFP)","route":"/terms/afp/"},{"id":"autologous-transplant","kind":"term","name":"Autologous stem cell transplant (ASCT)","route":"/terms/autologous-transplant/"},{"id":"tumour-markers","kind":"term","name":"Tumour markers (CEA, LDH, chromogranin, thyroglobulin)","route":"/terms/tumour-markers/"}],"trial":[{"id":"tiger-trial","kind":"trial","name":"TIGER: standard-dose TIP versus high-dose TI-CE with stem cell transplant as first salvage for relapsed germ cell tumours","route":"/trials/tiger-trial/"}],"paper":[{"id":"paper-who-2021-thymus-mediastinum-classification-marx-jto-2022","kind":"paper","name":"The 2021 WHO classification of tumours of the thymus and mediastinum: what is new in thymic epithelial, germ cell and mesenchymal tumours","route":"/key-papers/paper-who-2021-thymus-mediastinum-classification-marx-jto-2022/"}]}}