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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.
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.
How 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).
How 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.
Treatment 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.
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).
Central tumours arise in the large airways, peripheral ones in the alveoli; both drain to hilar then mediastinal nodes, and the pleural lining is a separate cancer site.
Same organ: Pleuropulmonary blastoma (types I, Ir, II and III), Type A and type AB thymoma, Type B1 and type B2 thymoma, Type B3 thymoma, Micronodular thymoma with lymphoid stroma, Adenocarcinoma of the lung, Squamous cell carcinoma of the lung, Large cell carcinoma of the lung, Sarcomatoid carcinoma of the lung, Adenosquamous carcinoma of the lung, Invasive mucinous adenocarcinoma of the lung, Adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung, Basaloid squamous cell carcinoma of the lung, Lymphoepithelial carcinoma of the lung, Pulmonary blastoma (adult), Non-small-cell lung cancer, Lung cancer (all types), Small-cell lung cancer, Mesothelioma, Pleural mesothelioma, Thymoma and thymic carcinoma, Childhood lung and airway tumours (pleuropulmonary blastoma, tracheobronchial tumours), Inflammatory myofibroblastic tumour (IMT), EGFR-mutated non-small-cell lung cancer, ALK-positive non-small-cell lung cancer, KRAS G12C-mutant non-small-cell lung cancer, ROS1-positive non-small-cell lung cancer, MET exon 14 and MET-amplified non-small-cell lung cancer, RET fusion-positive non-small-cell lung cancer, BRAF V600E-mutant non-small-cell lung cancer, HER2-mutant non-small-cell lung cancer, NTRK fusion-positive non-small-cell lung cancer, PD-L1-high non-small-cell lung cancer without a driver mutation, Resectable stage I to III non-small-cell lung cancer, Unresectable stage III non-small-cell lung cancer, Limited-stage small-cell lung cancer, Extensive-stage small-cell lung cancer, Lung neuroendocrine tumours (typical and atypical carcinoid), Thymoma (WHO types A, AB, B1, B2 and B3), Thymic carcinoma
Treated as extragonadal seminoma: cisplatin-based chemotherapy, with PET to judge residual masses.
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.
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Query for this cancer: (TITLE:"Mediastinal germ cell tumour" OR ABSTRACT:"Mediastinal germ cell tumour" OR TITLE:"Primary mediastinal germ cell tumour" OR ABSTRACT:"Primary mediastinal germ cell tumour" OR TITLE:"Mediastinal seminoma" OR ABSTRACT:"Mediastinal seminoma" OR TITLE:"Primary mediastinal non-seminomatous germ cell tumour" OR ABSTRACT:"Primary mediastinal non-seminomatous germ cell tumour" OR TITLE:"PMNSGCT" OR ABSTRACT:"PMNSGCT" OR TITLE:"Mediastinal teratoma" OR ABSTRACT:"Mediastinal teratoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Mediastinal germ cell tumour, not a curated reading list.
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Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
Pulmonary toxicity rises with G-CSF, high inspired oxygen, renal impairment and age over 40.
Reduce for CrCl below 50.
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
Reduce to 75% for CrCl 15-50.
Interstitial lung disease (ILD) is lung inflammation, a serious side effect of some ADCs (especially Enhertu) and immunotherapy.
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