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Print Date: May 18, 2013, 7:38 am
TitleAnterior Mediastinal Yolk Sac Tumor
TextYolk Sac Tumors, Mediastinal: Non-seminomatous Germ Cell Tumor
Also known as endodermal sinus tumors
>>Germ cell tumors constitute 10-15% of anterior mediastinal tumors. Malignant lesions occur with 9:1 ratio predominance for males, while benign lesions are found equally in either gender.
Germ cell tumors include Seminomas, Teratomas, and Non-seminomatous germ cell tumors (malignant). Of all mediastinal tumors, 1-3.5% are non-seminomatous germ cell tumors, which include yolk sac tumors, choriocarcinoma, teratocarcinoma, embryonal carcinoma, mixed germ cell tumors, and endodermal thymus tumors. Non-seminomatous germ cell tumors grow rapidly into large irregular masses and metastasize early. They often have areas of necrosis, hemorrhage, or cyst formation.
>>Symptoms: chest pain, cough, dyspnea, fever, weight loss, anorexia, hemoptysis; 85% of patients are symptomatic at diagnosis
>>Lab: Characteristically highly elevated alpha feto-protein and elevated LDH/lactate dehydrogenase
>>Pathology: pathognomonic Schiller-Duval bodies, which are perivascular formations of cells.
>>Epidemiology: young men 15-35 years old; 25% at diagnosis have metastasis in lung, liver, or brain. Also associated with increased incidence of AML (acute myelogenous leukemia)
20% of patients with non-seminomatous germ cell tumors have Klinefelters (47XXY)
>>Treatment: Chemotherapy: Cisplatin-based therapy BEP (bleomycin, etoposide, cisplatin) and surgical excision
>>Prognosis:Non-seminomatous germ cell tumors have a poorer prognosis than seminomas: 48% 5 year survival rate vs Seminomas 86% 5 year survival rate

References:Duwe BV , “Tumors of the Mediastinum”- Chest - 01-OCT-2005; 128(4): 2893-909
Macchiarini P- “Uncommon Primary Mediastinal Tumors” Lancet Oncol - 01-FEB-2004; 5(2): 107-18
Abeloff: Clinical Oncology, 3rd ed., 2004 Churchill Livingstone p.1770
ContributorSara J Quan (Uniformed Services University)
Peer ReviewerFang Gan (National Naval Medical Center Bethesda)
Record Number : 7122
Created2006-03-30 10:50:29-05
Modified2006-05-09 07:59:47.588227-04
Category:Neoplasm, malignant (NOS)
Location:Bethesda, MD
Sublocation:None Selected
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