Thirty patients with germ cell tumors originating in the mediastinum are reviewed and analyzed (20 embryonal carcinomas and 10 seminomas). Local control of the disease was successful by resection and/or external radiation in patients with seminoma; 50% were alive and well at 10 years. Patients with embryonal carcinoma were poorly controlled with surgery, radiation, or chemotherapy. However, early aggressive chemotherapy did seem to improve survival in embryonal carcinoma. Death by local recurrence was characteristic of embryonal carcinoma, whereas distant spread of disease, usually to bone and lymph nodes, was the cause of death in seminoma.
ERM CELL TUMORS ORIGINATING IN THE
G mediastinum are histologically identical to those originating in the genital organs.5.7.Q. 16,21,24 It is relatively uncommon for germ cell tumors of testicular origin to metastasize exclusively to the m e d i a ~t i n u m . * ~~2 ~ They usually metastasize to retroperitoneal lymph nodes, often bypassing the mediastinum via the thoracic duct.3J8,25 Rarely, generalized metastases of a testicular neoplasm are found without a viable or identifiable primary source in the genital organs.3.25 In such cases the metastases are not confined to the mediastinum. When a germ cell tumor presents in the mediastinum in the absence of a detectable testicular primary and in the absence of metastatic disease in the retroperitoneal lymph nodes, one may justifiably consider it a primary mediastinal tumor.
Methods
Thirty patients diagnosed as having primary germ cell tumors of the mediastinum were seen and treated at Memorial Sloan-Kettering Cancer Center from 1949 through 1971. T h e pathologic classification of these tu-~o I -s ~J * J Q , ~~ and the sex distribution are shown in Table 1.
T h e majority of patients was 15-35 years of age without difference in age distribution between pathologic types. T h e distribution of