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Open Access Highly Accessed Case report

Concurrent development of testicular seminoma and choriocarcinoma of the superior mediastinum, presented as cervical mass: a case report and implications about pathogenesis of germ-cell tumours

Giannis Mountzios16*, George Pavlakis2, Evangelos Terpos36, George Sakorafas4, Kyriakos Revelos5, Aristotelis Bamias1, Nikolaos Nikolaou2, Pantelis Papasavas2, Jean-Charles Soria7 and Meletios-Athanasios Dimopoulos1

Author affiliations

1 Medical Oncology Dpt, "Alexandra" University Hospital School of Medicine, Athens, Greece

2 Medical Oncology Dpt., 251 General Air force Hospital, Athens, Greece

3 Dpt. Of Haematology, 251 General Air force Hospital, Athens, Greece

4 1st Dpt. of Surgery, 251 General Air force Hospital, Athens, Greece

5 Dpt of Pathology, 251 General Air force Hospital, Athens, Greece

6 Dpt. of Biomedical Research 251 General Air force Hospital Athens, Greece

7 Dpt. Of Medicine, Institut Gustave Roussy, Villejuif, France

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Citation and License

BMC Clinical Pathology 2006, 6:8  doi:10.1186/1472-6890-6-8

Published: 20 November 2006

Abstract

Background

Synchronous presentation of more than one germ cell tumours of different histology in the same patient is considered to be very rare. In these cases of multiple germ cell tumours, strong theoretical and clinical data suggest an underlying common pathogenetic mechanism concerning genetic instability or abnormalities during the pluripotent embryonic differentiation and maturation of the germ cell.

Case presentation

A 25 year-old young man presented with an enlarging, slightly painful left cervical mass. Despite the initial disorientation of the diagnosis to a possible thyroid disorder, the patient underwent complete surgical resection of the mass revealing mediastinal choriocarcinoma. Subsequent ultrasound of the scrotum indicated the presence of a small lobular node in the upper pole of the left testicle and the patient underwent radical left inguinal orchiectomy disclosing a typical seminoma. Based on these results, the patient received 4 cycles of Bleomycin, Etoposide and Platinum chemotherapy experiencing only mild toxicity and resulting in complete ongoing clinical and biochemical remission.

Conclusion

The pathogenesis of concurrent germ cell tumours in the same patient remains an area of controversy. Although the genetic instability of the pluripotent germ cell offers an adequate explanation, the possibility of metastasis from the primary, less differentiated tumour to a distant location as a more mature subtype cannot be excluded. Possible development of a metastatic site of different histology and thus biological behaviour (e.g choriocarcinoma) should be anticipated. Furthermore, urologists, pathologists and medical oncologists should be meticulous in the original pathological diagnosis in these patients, since there is a significant frequency of germ cell tumours with mixed or overlapping histological elements with diverse potential of evolution and differentiation.