Unusual coexistence of a renal anomaly and germ cell tumor: An embryonal happenstance?
A 30-year-old gentleman presented to us with a 1-month history of left-sided chest pain. The positron emission tomography (PET)-computed tomography (CT) scan revealed a 13.3 cm × 14 cm mass in the left upper mediastinum (SUV Max 21.4) and an incidental HSK [Figure and ]. The testes were normal. A CT-guided biopsy of the mass revealed germ cell (Yolk sac) tumor, positive for CK, AFP and negative for C-kit, TTF1, CK7 and CD30. The serum alpha fetoprotein (AFP), beta human chorionic gonadotrophic hormone (β HCG) and lactate dehydrogenase (LDH) values were 16,093 ng/mL, <1.2 Miu/mL and 1013 U/L, respectively. The patient received chemotherapy with Paclitaxel (250 mg/m2; Day 1), Ifosphamide (1.2 gm/m2, Days 2-5) and Cisplatin (40 mg/ m2, Days 2–5) three weekly for four cycles (TIP).\nThe post-chemotherapy CT scan of the chest showed a residual mediastinal mass []. There was a decreasing trend in serum markers (AFP 39.8 ng/mL, β HCG <1.2 Miu/mL and LDH 250 U/L). The mass was subsequently excised and histopathology revealed a necrotic mass with no residual viable tumor. After 5 months, the patient presented with recurrent cough and raised serum LDH levels. The PET-CT scan showed a 3.2 cm × 5.2 cm recurrent mass in the anterior mediastinum (Max SUV 10.1) []. The re-excision of the tumor was done and histopathology showed a mature teratoma. The patient is currently on regular follow-up and is asymptomatic, disease free radiologically and biochemically.