Primary mediastinal seminoma presenting with superior vena caval obstruction

Description

A previously well 29-year-old man presented with a 2-week history of progressive orthopnoea, dry cough, neck and facial swelling, and night sweats. On further questioning, he described 2 kg of weight loss and increasing swallowing difficulties over the previous year. An oesophagogastroduodenoscopy performed 1 year prior was unremarkable. A chest radiograph demonstrated a large mediastinal mass (figure 1A), and a subsequent CT scan revealed a large anterior mediastinal mass measuring 11 cm in diameter. There was central necrosis and complete occlusion of the superior vena cava (SVC; figure 1C,D). An urgent biopsy of the mass was performed, and immunohistochemistry showed malignant cells positive for OCT3/4, placental alkaline phosphatase, D2-40 and CD117 but negative for pancytokeratin, S100, CD30, human chorionic gonadotropin (HCG), alpha-foetoprotein (AFP), CD45, CD20 and CD3. There were no masses found elsewhere on CT imaging of the chest, abdomen, pelvis and head, or on testicular ultrasonography....

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