Synchronous Primary Parosteal Osteosarcoma and Primary Mediastinal Germ Cell Tumour with Atypical Mycobacterial Infection – A Rare Phenomenon: A Case Report

@#Mediastinal germ cell tumours are a rare group of extragonadal germ cell tumours with less than 5% prevalence of all germ cell tumours. Primary mediastinal germ cell tumours themselves account for 16-36% of the extragonadal germ cell tumours. Along the spectrum of osteosarcoma, parosteal osteosarcoma is a welldifferentiated surface osteosarcoma with a prevalence of 4% of all osteosarcoma. As such synchronous primary parosteal osteosarcoma and primary mediastinal germ cell tumour are exceedingly rare. This leads to complexity in determining the most appropriate chemotherapy for two different types of tumours and its potential side effects of reduced immunity leading to potential secondary infection. Here we report a case of a 16-year-old boy who presented with synchronous primary osteosarcoma and primary mediastinal germ cell tumour, complicated with atypical mycobacterial infection post-operatively. Additionally, we discuss our choice of chemotherapy and the management of the atypical mycobacterial infection.

A Rare Case of Yolk Sac Tumour in Postmenopausal Lady

Epithelial tumours are the most common ovarian neoplasm in postmenopausal age group. Yolk sac tumour is a type of germ cell tumour which is common in younger age group. Occurrence of such tumour in postmenopausal women is extremely rare and not more than 55 cases have been reported so far in English literature. Often in such cases an association with benign or malignant epithelial tumours have been described. We report a strange case of Yolk sac tumour in a 57 year old postmenopausal lady who presented to us with chief complaints of abdominal distension and early satiety. She underwent exploratory laparotomy with presumed diagnosis of carcinoma ovary. Upon exploration she had extensive disease with peritoneal nodules and metastatic deposits over small bowel mesentery. Debulking surgery in form of total abdominal hysterectomy with bilateral oophorectomy, infracolic omentectomy and stripping of anterior peritoneum was done. Postoperative histopathological examination showed presence of high grade adeno carcinoma of left ovary with omental metastasis. On immunohistochemistry cells were immunoreactive for cytokeratin, Glypican 3, SALL 4 and negative for EMA,CK-7,CK-20,PAX8 and OCT 4.The clinical picture was consistent for Yolk Sac tumour. Postoperatively she was planned for chemotherapy with BEP. Her pulmonary function testing was suggestive of severe restrictive disease. She received one cycle of EP. One month later she developed ascites and melena and succumbed to her disease

CNS germinoma with extensive calcification: An unusual histologic finding

@#Introduction: Intratumoral calcification is a feature that is more often observed in pineal parenchymal tumour than germinoma. We describe a 13-year-old male with pineal region germinoma demonstrating extensive intratumoral calcification. Case report: He presented with worsening headache that was associated with fatigue, nausea and vomiting. Radiologic examination revealed a multilobular mass in the pineal region with internal calcifications. Biopsy showed a pure germinoma with unusually extensive calcification. Discussion: Although a diagnosis may be suggested with a careful evaluation of imaging, there is no pathognomonic pattern. Thus, histologic verification is necessary for most pineal region masses.

Mixed germ cell tumour of testis: a case report with review of literature.

Testicular tumours are rare neoplasm. Mixed germ cell tumour is the most common histological variant. Essentially, any admixture of the germ cell tumours as seen in pure form may be seen, one of the most common admixtures being embryonal carcinoma and teratoma. Unfortunately many of these patients present late usually with some complications. We present a rare case of mixed germ cell tumour with predominant embryonal carcinoma and yolk sac tumour in adolescent patient with multiple metastatic foci at the time of presentation.

A rare case of combined placental site trophoblastic tumour with mature cystic teratoma and mixed germ cell tumour in the testis

A 20-year-old male presented with persistent right testicular pain. Following ultrasound detection of testicular nodules and biopsy for intraoperative consultation which yielded germ cell tumour, he underwent radical orchidectomy. A predominantly whitish cyst and a lobulated, variegated nodule were identified. Histology showed a mature cystic teratoma with a focus of infiltrative epithelioid cells containing eosinophilic cytoplasm and pleomorphic nuclei, invading ectatic vessel wall associated with fibrinoid change. These cells were positive for cytokeratin, human placental lactogen and inhibin, while negative for Melan-A, p63 and alpha-fetoprotein, consistent with placental site trophoblastic tumor (PSTT). The variegated nodule was a mixed germ cell tumour composed of embryonal carcinoma and immature teratoma. Aside from choriocarcinoma, primary trophoblastic tumors such as PSTT, which are derived from intermediate trophoblasts, are extremely rare in the testis. Aside from a case of pure testicular PSTT, 2 other cases have been described in association with germ cell tumour, of which one is a mature teratoma with PSTT that demonstrated gain of chromosome 12p. The other presented with PSTT in retroperitoneal recurrence of a testicular mixed germ cell tumour. We discussed the features of this tumour in the testis and important differentials in its diagnosis.

Beta-human Chorionic Gonadotropin-secreting Lung Adenocarcinoma

Overexpression of beta-human chorionic gonadotropin (β-hCG) is frequently associated with germ cell tumours, especially choriocarcinoma. Ectopic secretion of β-hCG by non-small cell lung cancer is exceptional. We present an exceedingly rare case of pulmonary adenocarcinoma that secretes β-hCG. Our patient is a 62-year-old postmenopausal woman, a nonsmoker, who presented with a six-month history of progressive dyspnoea, associated with decreased appetite and significant weight loss. Her serum β-hCG was very high (11211.9 mIU/ml), which prompted investigations to exclude germ cell tumour. Radiological imaging revealed a 10-cm right lung mass with adrenal metastasis. No other focal lesions were detected. Microscopy of the lung biopsy specimen showed replacement of normal lung tissue by sheets of malignant cells, forming vague glands in some areas. Immunohistochemically, the malignant cells showed focal immunopositivity for thyroid transcription factor 1 (TTF-1), napsin A, cytokeratin 7 (CK7) and β-hCG. A diagnosis of β-hCG-secreting pulmonary poorly differentiated adenocarcinoma was rendered. Serum β-hCG level decreased significantly to 168.6 mIU/ml after the first cycle of chemotherapy. In conclusion, β-hCG expression in lung cancer should be recognised to facilitate prompt diagnosis and initiation of appropriate intervention.

A Testicular Cancer that was Thought to be an Inguino Scrotal Hernia

We present a case of a young man with a 5-year history of testicular swelling which was initially thought to be inguinoscrotal hernia. Intra-operatively it was found to be a testicular tumour and histopathological examination confirmed a mixed germ cell tumour. He had an orchidectomy and later underwent chemotherapy. It is interesting to note that the patient had kept the tumour for 5 years with no evidence of distant metastasis at diagnosis. This is probably the longest presentation of a testicular tumour.

Malignant mixed germ cell ovarian tumor in pregnant female.

Ovarian germ cell tumours comprise approximately 15% to 20% of all ovarian neoplasms. In pregnant females, its incidence is very low. They arise from primordial germ cells derived from the embryonal gonad. Malignant germ cell tumours comprise less than 5% of all ovarian neoplasms. Most malignant ovarian neoplasms in pregnant women are at early stages and are associated with good prognosis both for the mother and for the neonate. Histologic subtypes and prognosis do not differ from tumors not associated with pregnancy. Careful initial surgery with adequate staging biopsies followed by combination chemotherapy can greatly improve the prognosis of these patients. We present a case of malignant mixed germ cell tumor in a pregnant female who presented with abdominal mass after delivering a normal child. Histological and biochemical tumour markers confirmed it to be malignant mixed germ cell tumor.

Extra-gonadal Germ Cell Tumour – What About the Testis!

Extra-gonadal germ cell tumours (EGGCT) are rare. Therefore further investigations of the testis is aimed at sourcing a possible primary origin of gonadal tumour. Over the years, various case series on EGGCT have been reported questioning its true nature as in a majority of them, a primary source is found in the testis, thus representing a metastatic gonadal tumour. The testis pathology could be either a true germ cell foci, an intra-tubular epithelial neoplasia or an area of fibrosis, indicating a ‘burnt out tumour’. We report a 39-year-old male who underwent laparotomy and excision of a retroperitoneal tumour. Histopathological examination revealed retroperitoneal lymph node of mixed germ cell tumour origin. Clinical and ultrasound examination of bilateral testis was normal. The patient refused orchidectomy or a testicular biopsy. He underwent four cycles of bleomycin, cisplatin, and etoposide with no evidence of tumour recurrence on follow up and remains disease free after 12 months of diagnosis. A literature review of EGGCT, its relation and factors relating with future testicular tumour is presented.

Intracranial Germ Cell Tumour with extra cranial extension in a four month old infant – a case report.

Germ cell tumours of the central nervous system infiltrating the ipsilateral extracranial tissues are not a common presentation. A case of intracranial germ cell tumour with extracranial extension in a four month old infant is reported. The patient had undergone excision of the extracranial lesion followed by combination chemotherapy. Twelve months after the completion of the treatment the patient is doing fine and is on regular follow up.