Mediastinal germ cell tumors have long been the subject of fascination for pathologists and developmental biologists as well as a subject of controversy for clinicians. Speculations regarding etiology have ranged from the opinion that these tumors are really of gonadal origin and represent spread from an occult or “burned out” primary tumor to the view that these tumors are of true extragonadal origin with separate clinical and biological behaviors. Much recent work supports the latter notion that mediastinal germ cell tumors indeed represent a unique entity, and as such, require specialized management. The emerging picture of these unusual neoplasms will be the focus of this review. buy birth control online
Clinical Aspects of Mediastinal Germ Cell Tumors
Etiology: The initial theory regarding the genesis of mediastinal and other extragonadal germ cell tumors was that these tumors represented an isolated metastasis from an inapparent gonadal primary. This hypothesis was strengthened by the occasional demonstration of testicular scars in patients with a mediastinal or retroperitoneal primary tumor. More detailed work by Luna and colleagues2 suggested otherwise. Autopsy findings in 20 patients with extragonadal germ cell tumors arising in the anterior mediastinum revealed only one case of a testicular primary and one case of a well defined testicular scar. Large autopsy series of patients with testicular germ cell cancer confirm the rarity of isolated anterior mediastinal metastases with this finding being present in less than 1 percent of patients.
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