Key words: yolk sac tumor; Teilum tumor; non-gonadal germ cell tumor were normal. Imaging studies of the chest again showed Lisa Michaels, MD (Fellow Pediatric Oncology/ a large anterior mediastinal mass which was compressing Hematology)
the distal trachea and both mainstem bronchi resulting in The patient is a 16-year-old, previously healthy, Hissevere obstruction of the airway. panic male who presented to his local physician with a A single dose of methylprednisolone (1 mg/kg IV) was 1 month history of weight loss, fatigue, and dyspnea on given without discernible improvement in the patient's exertion. Initial evaluation revealed a hemoglobin of 5 tenuous clinical state, nor was there laboratory evidence g/dl, red cell microcytosis, and low serum iron. An upper of tumor lysis. The patient continued to deteriorate, re-GI barium study demonstrated compression of the mid quiring increasing ventilatory support and the addition of and distal esophagus. The patient then was "lost to folinotropic agents to improve perfusion of the extremities. low-up."
The general surgery, pulmonary, and anesthesiology One month later, the patient began to suffer worsening services were consulted and an open biopsy of the mass cough and dyspnea. He was seen in a local emergency was obtained the following day. The mass was identified room with complaint of shortness of breath, and pressure as a yolk sac (endodermal sinus) tumor. in his chest.
Alpha-fetoprotein (AFP) was subsequently found to Physical examination revealed a pale, agitated young be 3,823 ng/ml; Beta hCG (HCG) was normal. man. The patient was tachypneic with a respiratory rate Dr. Long, could you review the findings in this patient? of 40/min. The heart rate was elevated at 130/min. Blood
Frederick Long, MD (Radiology Fellow) pressure was 120/80 mm/Hg. Breath sounds were decreased on the left, and heart sounds were distant and
The plain films showed an anterior mediastinal mass muffled. There was no lymphadenopathy and the liver compressing the trachea and carina with opacification of and spleen were not enlarged.
the right lower lung (Fig. 1). Fluid accumulation and Laboratory studies included a complete blood count atelectasis appeared likely to be responsible for at least with hemoglobin 6.7 g/dl, platelets 178,000/mm 3 , and part of the findings on the right. A follow-up MRI clarified white blood cell count 16,400/mm 3 with a differential of this situation (Fig. 2). There is no aeration in the right 82% neutrophils, 14% lymphocytes, and 4% monocytes. The LDH was elevated at 1,253 UL and the uric acid was normal. Chest roentgenograms demonstrated a large 1 Division of Pediatric Oncology, and the 2 Departments of Radiology, anterior mediastinal mass, right pleural effusion and carand 3 Pathology, Children's Hospital of Philadelphia, Pennsylvania. diomegaly. An ECG was notable for decreased voltages Dr. Rozan's present address is Tulane Medical Center, 1430 Tulane in all leads. Echocardiogram revealed a large pericardial Ave., Box 5673, New Orleans, LA 70112. effusion (est. 600cc) and compression of the right ventri-Dr. Long's present address is Children's Hospital, Department of Radi- cle by the large mediastinal mass.