CTICasesPrimary Mediastinal Germ Cell Tumor (Seminoma)
Imaging findings
A young person presented with a large, mostly homogeneous anterior mediastinal mass abutting but not crossing the midline, with regions of low attenuation and a tiny focus of calcification, compressing and squashing the superior vena cava. Testicular ultrasound was normal, and biopsy with immunohistochemistry demonstrated a primary mediastinal germ cell tumor, favoring seminoma over non-seminomatous histology.
Key takeaways
A large, relatively homogeneous anterior mediastinal mass with SVC compression in a young patient should raise primary mediastinal germ cell tumor even with a normal testicular ultrasound, since these tumors can arise primarily in the mediastinum; extensive immunohistochemistry is often required to distinguish seminomatous from non-seminomatous subtypes.
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