Management of Malignant Mediastinal Germ Cell Tumors: The initial problem in the management of patients with suspected malignant mediastinal germ cell tumors is establishing the diagnosis. Elevation of serum tumor markers (AFP, HCG) in a young man with a mediastinal mass is very suggestive of a mediastinal germ cell tumor. Whenever possible, a tissue diagnosis should be obtained to determine histologic subtype, the presence of nongerm cell elements within the germ cell cancer or the rare patient with marker-positive nonsmall cell lung cancer. As with benign teratoma, malignant germ cell tumors of the mediastinum are commonly adherent to intra-thoracic structures. Cheap Diskus Advair
In institutions with experienced cytopathologists, fine needle aspiration frequently provides histopathologic confirmation of a suspected mediastinal germ cell tumor. If cytopathology is unavailable or attempts at fine needle aspiration fail to establish the diagnosis, anterior median sternotomy offers the best surgical alternative to cytologic diagnosis. The procedure is safe, avoids a thoracotomy, and allows for institution of chemotherapy soon after the procedure is complete. Heroic efforts at resection should not be undertaken as initial management. Occasionally, one is faced with a patient too ill from compressive symptoms or metastatic disease to undergo even simple surgical procedures. In this setting, if serum AFP or HCG are elevated, it is appropriate to proceed with primary management with chemotherapy without histopathologic confirmation.
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