Mediastinal germ cell tumor
Chest pain and heaviness. CXR shows a mediastinal mass.
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Large lobulated heterogeneously enhancing solid mass lesion in anterior, superior and middle mediastinum. Multiple hypodense areas are noted within the mass lesion. It is measuring 19.3x12.5x10.4cm in TRxCCxAP dimensions. It is encasing and compressing the heart and great vasculature of the mediastinum. It is infiltrating into the superior vena cava. It is causing compression over the trachea and mainstem bronchi more so on the left side. The left brachiocephalic vein is not visualized likely be compressed. Anteriorly the mass is closely abutting the anterior chest wall, sternum and both clavicles at the sternoclavicular joint without obvious erosion and destruction.
Multiple parenchymal and subpleural metastatic nodules are seen scattered in both lungs. The largest nodule is measuring 1.8x1.4cm in the lateral basal segment of the right lower lobe.
Few collateral channels are noted in the neck and in posterior chest wall due to infiltration of the superior vena cava by the mass lesion.
No pleural effusion or pneumothorax.
Included sections through the upper abdomen are demonstrating multiple well-circumscribed hypodense lesions in the liver, the largest one measures 5.2x4.7cm seen in segment VIII of right lobe consistent with metastatic lesions.
The rest of the visualized included upper abdominal viscera are grossly unremarkable.
Few Schmorl's nodes along the endplates of the lower dorsal and lumbar spine are noted. No lytic or blastic lesion is identified.
Biopsy of the mediastinal mass showed germ cell tumor on histopathology. The patient underwent radiotherapy.