A case presented mediastinal abnormal shadow

: A 29-year-old Japanese man was admitted to our hospital because of further examination of his mediastinal abnormal shadow on the chest roentogenogram detected in an annual medical examination. He was asymptomatic and had no abnormal findings on physical examination. A CT scan of the chest demonstrated a well marginated large tumor, 8 x 6 cm in size, in the anterior mediastinum. Non-invasive thymoma, malignant lymphoma (Hodgkin's disease, T-cell lymphoblastic lymphoma, mediastinal large cell lymphoma with sclerosis etc) or germ cell tumor were considered for differential diagnosis and diagnostic procedures were taken. Results of venous blood examination were normal except for high titer of beta-HCG (20.4 mIU/ml). With a transcutaneous biopsy of the mediastinal tumor, it was diagnosed mediastinal seminoma. A three weeks-interval chemotherapy composed of cisplatin, etoposide, and bleomycin was performed. After four cycles of this chemotherapy the residual mass was resected and no viable tumor cells were shown in the specimen. Germ cell tumor is usually treated with combination of chemotherapy, radiotherapy and surgical resection. However, mediastinal germ call tumor is not a common disease and it remains to be clarified which treatment modalities are adequate. But it is obvious that surgical resection should not be the initial choice of treatment. Medical oncologists must carefully perform the most appropriate modality at an optimal timing.