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5 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
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).
| Setting | Approach | Guideline |
|---|---|---|
| Mediastinal seminoma | Treated as extragonadal seminoma: cisplatin-based chemotherapy, with PET to judge residual masses. | not mapped |
| Mediastinal non-seminoma | 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. | not mapped |