CTICasesMediastinal Germ Cell Tumor (Yolk Sac Tumor / Mature Teratoma After Treatment)
Imaging findings
CT demonstrates a large anterior mediastinal mass with heterogeneous attenuation in a young patient. Serial imaging shows the mass was initially very large and biopsied to yield yolk sac tumor. Following chemotherapy, the AFP normalized and subsequent resection of the remaining large mass revealed only mature teratoma on pathology, indicating the chemotherapy successfully eradicated the malignant yolk sac component while leaving the benign teratomatous elements intact.
Key takeaways
Mixed germ cell tumors of the mediastinum commonly contain both malignant elements such as yolk sac tumor and benign elements such as mature teratoma. Chemotherapy can selectively eradicate the chemosensitive malignant components while leaving the benign teratoma intact, a phenomenon that explains why a large residual mass may persist after AFP normalization. Surgical resection of the residual mass following chemotherapy may reveal only mature teratoma, which represents a favorable pathological finding and does not indicate treatment failure.
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