Unusual scapular metastasis as initial manifestation of advanced nonseminomatous germ cell tumor of the mediastinum.
Primary malignant germ cell tumors of the mediastinum are relatively rare, occurring predominantly in young male adults, and have a poor prognosis. We present a case of a 27-year-old man who initially experienced a persistent, intractable painful sensation over the right lower scapula despite taking an analgesic agent for 2 months. A scapular x-ray film and a whole-body bone scan showed an expansile osteolytic lesion. Excisional biopsy of the scapula revealed a metastatic carcinoma, suggestive of nonseminomatous germ cell tumor origin. Further examination of the whole abdomen and bilateral testes were negative. Chest computed tomography and magnetic resonance imaging showed a primary tumor mass in the anterior mediastinum. Chemotherapy with cisplatin, bleomycin, and etoposide was administered for six courses. The mediastinal tumor mass was markedly reduced in size and remission without evidence of tracer uptake by [(18)F]fluorodeoxyglucose positron emission tomography examination. Six months after chemotherapy, the patient received advanced surgical intervention to remove the mediastinal tumor, the pathologic features of which were similar to the previous scapular lesion. He was doing well at 1-year follow-up.
Cheng
Ming-Fang
MF
Department of Pathology, Tri-Service General Hospital and National Defense Medical Center, Tapei, Taiwan.
Peng
Yi-Jen
YJ
Huang
Guo-Shu
GS
Lee
Chian-Her
CH
Chiang
Pei-Chun
PC
Lee
Herng-Sheng
HS
D000328:Adult; D001706:Biopsy; D001859:Bone Neoplasms / Q000175:diagnosis / Q000556:secondary*; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000556:secondary*; D012540:Scapula; D014057:Tomography, X-Ray Computed