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Primary Mediastinal Non-Seminomatous Germ Cell Tumor: 4

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MRI shows the relationship to the great vessels of the heart. Echocardiogram showed a 65% ejection fraction with no IVC or intramural thrombus. The patient underwent video-assisted thoracoscopy (VATS) to biopsy the mass. The pathology showed the yolk sac variant of non-seminomatous germ cell tumor. Alfa-fetoprotein level came back at 19,829. PET, brain and bone scans were negative for metastatic disease. Testicular ultrasound showed no lesions. The patient underwent two cycles of BEP (bleomycin 30u X1 on day 2; etoposide 204 mg daily d1-5; cisplatin 40.7 mg daily d1-5.) The patientís AFP plateaued at ~7,000 without the hoped for logarithmic decrease indicative of a responsive tumor. The tumor was deemed refractory and the third cycle of chemo was aborted. The patient was recommended for surgery.  

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Primary Mediastinal Non-Seminomatous Germ Cell Tumor: 5

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The patient was taken to the operating room and the femoral vessels were exposed in the event that cardiopulmonary bypass (see aortic valve replacement) became necessary.       

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Primary Mediastinal Non-Seminomatous Germ Cell Tumor: 6

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The chest was opened through a median sternotomy.     

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This page was last modified on 3/3/2006.