CTICasesMetastatic P-NET Tumor from Malignant Transformation of Germ Cell Tumor
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Imaging findings
In July 2012, the patient presented with a left upper quadrant mass and liver lesions, with the abdominal mass being predominantly cystic. By June 2013, a cystic lesion was noted in the right upper lobe, likely representing a lesion that cavitated in response to chemotherapy. In October 2013, a large, solid lesion developed in the right upper lobe, invading the mediastinum. By early 2014, there was extensive tumor growth in the mediastinum with substantial compression of mediastinal structures and airways.
Key takeaways
The abdominal mass was initially diagnosed as a metastatic germ cell tumor with a yolk sac component, for which the patient received chemotherapy. Subsequently, the right lung lesion pathology was consistent with a metastatic P-NET (primitive neuroectodermal tumor). Review of the previous retroperitoneal mass revealed areas of P-NET within that tumor as well. This complex case illustrates malignant transformation of a germ cell tumor with a teratomatous component, which can lead to various histologies, including sarcomas, carcinomas, and P-NETs. The P-NETs in this context are typically central P-NETs. This represents a complicated pathological course with varied pathology.
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