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Mediastinal germ cell tumor with associated myeloid sarcoma: An exceptional co-occurrence

  • Renu Sukumaran
  • Rekha A. NairEmail author
  • Anil Prahladan
  • Anitha Mathews
Case Report
  • 5 Downloads

Abstract

The association of mediastinal germ cell tumor (GCT) and hematological malignancy is a well-documented but extremely rare phenomenon. This syndrome is characterized by the occurrence of nonseminomatous mediastinal germ cell tumor and an associated hematological neoplasm that usually involve the megakaryocytic lineage. The hematopoietic malignancies can involve the mediastinum or present as infiltration of bone marrow or lymphoid organs. In majority of cases, the hematological malignancy was detected in the bone marrow simultaneously or within 6 months after the detection of mediastinal germ cell tumor. There are very few limited case reports on the presence of hematopoietic or leukemic cells within the germ cell tumor itself and mass formation due to myeloid sarcoma is exceptionally rare. Herein we report the case of a 36-year-old male patient with a large mediastinal mass, excision biopsy of which showed areas of yolk sac tumor, immature teratoma and a separate round cell component. On immunohistochemical examination, the round cell component showed positivity for CD45 (dim), CD43, MPO, CD11c, and CD68 and were negative for CD117, CD20, CD5, CD34, Tdt, CD30, CD123, and CD61. A diagnosis of mediastinal germ cell tumor with yolk sac tumor and immature teratoma components and associated myeloid sarcoma was given. Peripheral smear and bone marrow examination showed no evidence of leukemic involvement.

Keywords

Mediastinal germ cell tumor Myeloid sarcoma Yolk sac tumor 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Nichols CR, Hoffman R, Einhorn LH, Williams SD, Wheeler LA, Garnick MB (1985) Hematological malignancies associated with primary mediastinal germ cell tumors. Ann Intern Med 102:603–609CrossRefGoogle Scholar
  2. 2.
    Orazi A, Wick MR, Hartmann JT, Marx A (2004) Germ cell tumours with associated hematologic malignancies. In: Travis WD, Brambilla E, Muller-Hermelink HK, Harris CC (eds) World Health Organization classification of tumours. Pathology and genetics of tumours of the lung, pleura, thymus and heart. IARC Press, Lyon, pp 219–220Google Scholar
  3. 3.
    Hartmann JT, Nichols CR, Droz JP, Horwich A, Gerl A, Fossa SD, Beyer J, Pont J, Fizazi K, Einhorn L, Kanz L, Bokemeyer C (2000) Hematologic disorders associated with primary mediastinal nonseminomatous germ cell tumours. J Natl Cancer Inst 92:54–61CrossRefGoogle Scholar
  4. 4.
    Takeda S, Miyoshi S, Ohta M, Minami M, Masaoka A, Matsuda H (2003) Primary germ cell tumors in mediastinum: a 50-year experience at a single Japanese institution. Cancer 97:367–376CrossRefGoogle Scholar
  5. 5.
    Garnick MB, Griffin JD (1983) Idiopathic thrombocytopenia in association with extragonadal germ cell cancer. Ann Intern Med 98:926–927CrossRefGoogle Scholar
  6. 6.
    Baron MH, Isern J, Fraser ST (2012) The embryonic origins of erythropoiesis in mammals. Blood 119:4828–4837CrossRefGoogle Scholar
  7. 7.
    Vardiman JW, Arber DA, Brunning RD, Larson RA, Matutes E, Baumann I, Thiele J (2008) Therapy-related myeloid neoplasms. In: Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, Vardiman JW (eds) WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues., 4th edn. IARC Press, Lyon, pp 127–129Google Scholar
  8. 8.
    Saito A, Watanabe K, Kusakabe T, Abe M, Suzuki T (1998) Mediastinal mature teratoma with coexistence of angiosarcoma, granulocytic sarcoma and a hematopoietic region in the tumor: a rare case of association between hematological malignancy and mediastinal germ cell tumor. Pathol Int 48:749–753CrossRefGoogle Scholar
  9. 9.
    Orazi A, Neiman RS, Ulbright TM, Heerema NA, John K, Nichols CR (1993) Hematopoietic precursor cells within the yolk sac tumor component are the source of secondary hematopoietic malignancies in patients with mediastinal germ cell tumors. Cancer 71:3873–3881CrossRefGoogle Scholar
  10. 10.
    Ikdahl T, Josefsen D, Jakobsen E, Delabie J, Fosså SD (2008) Concurrent mediastinal germ-cell tumor and hematological malignancy: case report and short review of literature. Acta Oncol 47:466–469CrossRefGoogle Scholar
  11. 11.
    Oshrine BR, Olsen MN, Heneghan M, Wertheim G, Daber R, Wilmoth DM, Biegel JA, Pawel B, Aplenc R, King RL (2014) Acquired isochromosome 12p, somatic TP53 and PTEN mutations, and a germline ATM variant in an adolescent male with concurrent acute megakaryoblastic leukemia and mediastinal germ cell tumor. Cancer Genet 207:153–159CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Renu Sukumaran
    • 1
  • Rekha A. Nair
    • 1
    Email author
  • Anil Prahladan
    • 2
  • Anitha Mathews
    • 1
  1. 1.Division of PathologyRegional Cancer CentreThiruvananthapuramIndia
  2. 2.Division of ImageologyRegional Cancer CentreThiruvananthapuramIndia

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