J Korean Med Sci.  2015 Aug;30(8):1085-1091. 10.3346/jkms.2015.30.8.1085.

Exuberant Vasculoconnective Component in Mediastinal Mixed Germ Cell Tumors

• Cha YJ
• Han J
• Lee KS
• Shim YM

• KMID: 2164503
• DOI: http://doi.org/10.3346/jkms.2015.30.8.1085

Abstract

We aimed to evaluate the histologic components of primary mediastinal mixed germ cell tumors. A total of 221 patients diagnosed with a mediastinal germ cell tumor (GCT) were retrospectively reviewed. Among them, 14 patients underwent surgical resection after chemotherapy and 8 patients were diagnosed with mixed GCT, who were then selected for further evaluation. Clinical chart review and histologic review of biopsy and surgical specimens of 8 patients were performed. All 8 patients were young males and showed a mature teratoma or a mature teratoma with a focal immature teratoma in the resected specimens. Serum alpha-feto protein was variably elevated. Seven patients experienced an increase in tumor size after the chemotherapy. In 5 patients, a variable amount of vasculoconnective tissue was found along with the mature teratoma occupying average 66.3% of resected mass, and 3 of them showed an identical vasculoconnective component on biopsy before chemotherapy. We suggest that vasculoconnective tissue might be the intrinsic component of primary mediastinal mixed GCT. When vasculoconnective tissue is obtained on small biopsy of an anterior mediastinal mass of a young male, the possibility of underlying mixed GCT should be considered and further clinical work up should be performed.

Keyword

Neoplasms, Germ Cell and Embryonal; Mediastinal Neoplasms; Pathology, Vasculoconnective Tissue

MeSH Terms

Adolescent
Adult
Blood Vessels/*pathology
Connective Tissue/*pathology
Diagnosis, Differential
Humans
Male
Mediastinal Neoplasms/*pathology
Middle Aged
Neoplasms, Germ Cell and Embryonal/*pathology
Teratoma/*pathology
Young Adult

Figure

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  Fig. 1 Resected mediastinal mixed germ cell tumor gross specimen. The mass is well circumscribed, which corresponds to the gross feature of a teratoma. The cut surface shows necrosis, hemorrhage and cystic change.

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  Fig. 2 Low-power view of 5 resected mediastinal germ cell tumors after chemotherapy harboring a vasculoconnective component (Hematoxylin and eosin staining, magnification, × 12.5). With variable degrees of hemorrhage, cystically delated glandular components and cartilaginous components of the mature teratoma are easily seen. Since the vasculoconnective components are intermingled with the underlying teratoma, there is no discernable mass-like lesion under low-power magnification. (A, case 1; B, case 2; C, case 3; D, case 4; E, case 5).

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  Fig. 3 Biopsy specimen before chemotherapy (A, C, E, G, I, J) and the vasculoconnective component in the resected specimen after chemotherapy (B, D, F, H, K) (Hematoxylin and eosin staining, magnification, ×40, magnification of inbox, ×200). Only two biopsy specimens (case 2, C and case 5, J) were diagnostic for a germ cell tumor (GCT). In two patients (case 2 and case 4), a variable degree of cellular atypia is found in the resected specimen (D and H, inbox). In case 5, the first biopsy shows no identifiable GCT component (I). However, in the second biopsy, an embryonal carcinoma-like area is detected (J). Histological features of the vasculoconnective components were insufficient for diagnosis of angiosarcoma (Case 1, A and B; Case 2, C and D; Case 3, E and F; Case 4, G and H; Case 5, I, J, and K).

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  Fig. 4 A resected mediastinal mass without prior chemotherapy from an 18-yr-old male patient. Grossly, the mass is well circumscribed, and hemorrhage and cystic changes are found on the cut surface (A). Microscopically, the mass is composed of a mature teratoma, yolk sac tumor, and an abundant vasculoconnective component (B, Hematoxylin and eosin staining, magnification, ×12.5). On high-power view, the vasculoconnective component is seen to be intermingled with the yolk sac tumor (C, Hematoxylin and eosin staining, magnification, ×100). An epidermal element with keratin is seen in the left lower corner (C).

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