The diagnostic and prognostic value of tumor markers in giant mediastinal endodermal sinus tumor with prolonged survival: Twelve-year follow up after radical resection

Abstract

We report a case of 16 -year male who presented with nonproductive cough, chest pain, and hemoptysis. His chest -x-ray and computerized tomographic scan (CT) of the thorax with contrast enhancement revealed a large mediastinal mass mostly occupying the left hemithorax. Percutaneous CT scan-guided biopsy of the mediastinal mass was reported as an endodermal sinus tumor (EDST). Serum alpha-fetoprotein levels were markedly raised (120,000 ng/ml). After completion of chemotherapy repeat, CT scan of the thorax revealed a large residual mass. Radical resection of the tumor was carried out. Twelve-year post-surgical resection follow-up with serial serum alpha-fetoprotein (AFP) tumor marker levels and CT scan of the thorax showed no recurrence.

Keywords: Alpha-fetoprotein; Chemotherapy; Endodermal sinus tumor; Mediastinum; Surgery.

Fig. 1

(A, B, C) CT scan of thorax Axial, coronal &Sagittal view showing large mediastinal mass mostly occupying the left hemi thorax. (D, E, &F) Post chemotherapy CT scan of thorax showing a large Residual anterior mediastinal residual mass.

Fig. 2

CT scan of thorax after radical resection showing no residual tumor (Serial CT scans were done yearly this CT scan is after 12 years after surgery).

Fig. 3

Operative pictures (A) after median sternotomy and application of retractor showing large tumor (B) Tumor resected with part of pericardium and meticulously dissected free from Innominate veins, SVC, Aorta and Pulmonary vessels (C) view after the complete resection of tumor (D) Macroscopic picture of the resected specimen.

Fig. 4

Figure: 4 A linear graph showing Alpha Feto protein (AFP) tumor marker levels in ng/dl pre-operative and post-operative comparison over a period of 13 years (2009–2021).