Abstract
A 40-year-old man presented to our hospital with right chest and back pain and dyspnea on effort. Chest computed tomography revealed an anterior mediastinal tumor, of about 14 cm in diameter, and massive effusion in the right pleural cavity. Laboratory data showed an elevated serum level of alpha-fetoprotein (AFP), which was 699.2 ng/mL. Bloody effusions were evacuated from the right pleural cavity. It was diagnosed as mediastinal germ cell tumor with right hemothorax. Because there was progression of anemia, continuous intrathoracic hemorrhage was suspected. An emergency operation was performed and the tumor was resected. Pathological evaluation revealed a mixed germ cell tumor which consisted of a yolk sac tumor and immature teratoma. Microscopically, the causes and locations of bleeding and the findings of the tumor rupture were unclear. The tumor did not invade the neighboring organs, and complete resection of the tumor was performed. Postoperatively, the patient has been observed without adjuvant chemotherapy and no recurrent findings have been noted. Mediastinal germ cell tumors are rare, and few cases with hemorrhage have been reported. Because surgery after chemotherapy is generally recommended and the outcome of surgery alone is not clear, it requires strict observation.
