|Year : 2022 | Volume
| Issue : 3 | Page : 121-123
Syncope – An Unusual Presentation of Mediastinal Seminoma
Ria Lawrence1, Gayathri Anur Ramakrishnan2, Mohammed Zehran2
1 Department of Pulmonology, Apollo Hospital, Chennai, Tamil Nadu, India
2 Department of Oncology, Apollo Hospital, Chennai, Tamil Nadu, India
|Date of Submission||20-Sep-2022|
|Date of Decision||24-Oct-2022|
|Date of Acceptance||25-Nov-2022|
|Date of Web Publication||01-Mar-2023|
Dr. Ria Lawrence
W 147, B Sector-4th Street, Anna Nagar West Extension, Chennai - 600 101, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Mediastinal tumors are commonly found in the anterior mediastinum, among which thymic tumors and lymphoma are the most common ones. Germ cell tumors constitute about 10%–15% of mediastinal tumors. Among which seminoma is an uncommon tumor. These mediastinal masses usually present with complaints of cough, chest pain, or symptoms of superior vena cava obstruction. Here, we report a case of mediastinal seminoma in a young adult presenting with complaints of syncope.
Keywords: Anterior mediastinal mass, germ cell tumor, mediastinal germ cell tumor, mediastinal seminoma, presentation of seminoma, seminoma, syncope
|How to cite this article:|
Lawrence R, Ramakrishnan GA, Zehran M. Syncope – An Unusual Presentation of Mediastinal Seminoma. J Assoc Pulmonologist Tamilnadu 2022;5:121-3
|How to cite this URL:|
Lawrence R, Ramakrishnan GA, Zehran M. Syncope – An Unusual Presentation of Mediastinal Seminoma. J Assoc Pulmonologist Tamilnadu [serial online] 2022 [cited 2023 Mar 21];5:121-3. Available from: https://www.japt.in//text.asp?2022/5/3/121/370811
| Background|| |
The anterior mediastinum is the space between the lungs that houses the thymus, heart, large blood vessels, lymph nodes, nerves, and portions of the esophagus and trachea. The most common tumors of the anterior mediastinum are thymic malignancies and lymphoma. Other causes include endocrine tumors, teratomas, germ cell tumors, and benign thymic lesions. The common presenting symptom is cough, which is seen in 60% of the patients. Other common symptoms are chest pain, dyspnea, hoarseness of voice, hemoptysis, and dysphagia. Germ cell tumors may cause compression of the superior vena cava. Here, we report a patient having syncope, as the presenting symptom of a germ cell tumor of the anterior mediastinum.
| Case Report|| |
A 24-year-old male, with no known comorbid, presented with complaints of syncope during exercise. There was no history of cough, fever, chest pain, hemoptysis, loss of weight, or appetite. On examination, he was afebrile, with oxygen saturation on room air at 97%, on auscultation, the chest was clear, with no palpable cervical lymphadenopathy, or scrotal swelling. Upon investigating for syncope, chest X-ray showed mediastinal widening and cardiac workup was normal. Computed tomography (CT) chest revealed anterior mediastinal mass [Figure 1], which was better delineated by positron emission tomography CT [Figure 2], [Figure 3], [Figure 4], which showed well-defined heterogeneously fluorodeoxyglucose avid and mildly enhancing lobulated soft-tissue mass with irregular contours in the anterior mediastinum on the left side of the midline, measuring 8.7 (T) × 8.1 (AP) × 5.5 (CC) cm with standardized uptake value max 12.0. The mass was abutting and encasing the arch of the aorta, the main pulmonary trunk, and the left pulmonary artery. No evidence of thrombus was seen within. Medially, the mass extended into the left paratracheal and aortopulmonary window regions. The mass abutted the costal pleura anterolaterally and the superior aspect of the pericardium inferiorly. Tumor biomarkers were done and were normal: serum alpha-fetoprotein 1.34 ng/ml and beta-HCG 6.76 mIU/ml. CT-guided lung biopsy was done, and histopathological examination revealed germ cell tumor consistent with seminoma. Immunohistochemistry was done, and placental alkaline phosphatase (PLAP)/SALL/CD3/CD20 was positive. He was referred to a medical oncologist and started on chemotherapy with cisplatin, bleomycin, and etoposide and he completed three cycles of treatment.
|Figure 1: CT Chest with contrast showing left-sided anterior mediastinal mass with the mass abutting and encasing the arch of the aorta, main pulmonary trunk, and the left pulmonary artery. CT: computed tomography.|
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|Figure 2: PET CT whole body showing FDG avid and mildly enhancing lobulated soft tissue mass with irregular contours in the anterior mediastinum with SUV max 12.0. PET CT: Positron emission tomography computed tomography, FDG: Fluorodeoxyglucose, SUV: Standardized uptake value|
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|Figure 3: PET CT whole body showing FDG avid and mildly enhancing lobulated soft-tissue mass with irregular contours in the anterior mediastinum with SUV max 12.0. PET CT: Positron emission tomography computed tomography, FDG: Fluorodeoxyglucose, SUV: Standardized uptake value|
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|Figure 4: PET CT whole body showing FDG avid and mildly enhancing lobulated soft tissue mass with irregular contours in the anterior mediastinum with SUV max 12.0. PET CT: Positron emission tomography computed tomography, FDG: Fluorodeoxyglucose, SUV: Standardized uptake value|
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| Discussion|| |
The common etiologies of anterior mediastinal mass include thymic malignancies with an incidence of about 35% and lymphoma with an incidence of about 10%. About 5%–7% of germ cell tumors occur outside the gonadal organs, out of which the mediastinum is the common site. The incidence of germ cell tumors in the anterior mediastinum is about 5%–10%. The tumor is most commonly seen in the anterosuperior mediastinum. The most commonly affected age group is between 20 and 40 years. Mediastinal seminomas usually have a very slow growth with less chances of metastasis. The overall 5-year survival is around 87%–100%. Immunohistochemistry of the mediastinal seminoma shows CAM 5.2%–80% to 90% positivity, PLAP, and vimentin. CD 117 is also positive in the cell membrane, and there is often a paranuclear Golgi pattern present. The first-line treatment is chemotherapy and radiotherapy. Cisplatin-based chemotherapy with a combination of etoposide and bleomycin is recommended as first-line treatment. Bleomycin is avoided if the patient has an underlying pulmonary disease. Ifosfamide can be added to the regimen of cisplatin and etoposide for 3–4 cycles. Radiation has been extremely successful in mediastinal seminomas.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]