In all cases, the mediastinal primary was a nonseminomatous variant. The hematologic malignancy was characterized as acute megakaryocytic leukemia in six patients, mixed lineage acute leukemia (erythroid plus megakaryocytic) in one patient, acute monocytic leukemia in one patient, acute myelomon-ocytic leukemia in one patient, acute undifferentiated leukemia in one patient, myelodysplastic syndrome in two patients, extramedullary megakaryocytic myelosis in two patients, and two patients with massively elevated platelet counts (Table 1). The median time to development of the hematologic malignancy was six months, and five of the 16 patients had simultaneous presentations of the two disorders. Cytogenetic analysis of bone marrow revealed Trisomy 8 in two patients, 47,XXY in one patient, and one patient with the marker chromosome, i(12p).
Review of the literature supports these findings with reports of 28 additional patients with mediastinal germ cell tumors and hematologic disorders (Table 1). In this review, the median interval between the two diagnoses was five months, and there were 12 cases of the simultaneous presentation of the mediastinal germ cell tumor and the hematologic malignancy. Again, all patients had nonseminomatous mediastinal germ cell primaries. antibiotic levaquin
That these cases of hematologic malignancies were not related to the. therapy given for the mediastinal germ cell tumor was suggested by clinical features present in these patients as well as review of similarly treated testicular cancer patients.
Table 1—Hematologic Disorders Associated with Mediastinal Nonseminomatous Germ Cell Tumors
|Acute megakaryocytic leukemia (M7)||6||1|
|Acute nonlymphocytic leukemia (Not M7)||4||15|
|Acute lymphoblastic leukemia||3|
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