A case of mediastinal seminoma undergoing extremely cystic degeneration
Department of Respiratory Surgery, Hirosima City Hospital.Nihon Kyōbu Shikkan Gakkai zasshi 11/1997; 35(10):1108-12.
A-25-year-old male had an abnormal shadow on chest X-ray. CT and MRI films revealed a cystic lesion, with irregular nodules in the right anterior mediastinum. A cystic teratoma was suggested. Antero-axillary thoracotomy revealed a cystic lesion originating from the right lobe of the thymus. The lesion was extirpated, along with the right lobe of the thymus. The cystic part of the lesion, filled with brown fluid, was occupied by several masses originating from the wall of the tumor. Pathologically, the lesion was diagnosed as a seminoma undergoing cystic degeneration. The patient was given post-operative irradiation of 20Gy. No apparent recurrence has been detected 33 months after surgery. Mediastinal seminomas generally occur as a solid tumor consisting of stroma and tumor cells. However, this case report suggests that mediastinal seminomas may undergo extremely cystic degeneration.
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ABSTRACT: To analyze computed tomography (CT) features of primary non-teratomatous germ cell tumors of the mediastinum and to improve the diagnostic efficacy of CT for such tumor. Fifteen patients with primary non-teratomatous germ cell tumors of the mediastinum, proven pathologically, were enrolled. All patients underwent non-enhanced and contrast-enhanced CT examinations. The CT features, including location, size, shape, edge, CT attenuation, involvement of adjacent structure and local or distant metastasis of each lesion were retrospectively analyzed. Each case showed single mass, a total of 15 masses. 11 masses arose within the left anterosuperior mediastinum and 4 masses arose within the right anterosuperior mediastinum. 10 masses appeared lobulated and ill-circumscribed, and 5 masses appeared rounded or oval and well-circumscribed. The maximal diameter of all the masses ranged from 5 cm to 16 cm (mean, 11 cm). 12 masses revealed heterogeneous attenuation on non-enhanced CT images with patchy low-attenuation foci and stippled calcification, and showed moderately heterogeneous enhancement after contrast administration. 3 masses of the patients with seminoma revealed homogeneous attenuation on non-enhanced CT images and showed lightly homogeneous enhancement after contrast administration. Pericardial effusion, pleural effusion and involvement of adjacent vascular structures were observed in 6, 5 and 10 cases, respectively. Pulmonary metastasis were observed in 3 cases. The characteristic CT findings of primary non-teratomatous germ cell tumors of the mediastinum include bulky, ill-circumscribed, lobulated masses, heterogeneous attenuation with low-attenuation foci and calcification on non-enhanced CT images and heterogeneous enhancement after contrast administration. Seminomas may show homogeneous attenuation and homogeneous enhancement after contrast administration. The tumor is apt to involve pericardium, pleura and adjacent vascular structure and develop distant metastasis. Primary non-teratomatous germ cell tumors should be considered when anterosuperior mediastinal masses are detected with these findings, especially in young males.European journal of radiology 02/2011; 81(5):1057-61. DOI:10.1016/j.ejrad.2011.02.005 · 2.37 Impact Factor
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