title: Atypical extragonadal germ cell tumors.
abstract: OBJECTIVE
  To review the experience with the diagnosis and management of extragonadal germ cell tumors (GCT) with a subset analysis of those with atypical features.
  
  
  METHODS
  A retrospective chart review of patients of extragonadal germ cell tumors between 2000 and 2010 was carried out.
  
  
  RESULTS
  Fifteen children aged 7 days to 15 years (median, 1.5 years) were included. Three had an antenatal diagnosis (one sacrococcygeal, one retrobulbar, one retroperitoneal tumor) and were operated in the neonatal period. The locations were distributed between the retrobulbar area (1), anterior neck-thyroid gland (1), mediastinum (4), abdominothoracic extending through the esophageal hiatus (1), retroperitoneal (4) and sacrococcygeal (4). On histological examination, five harbored immature elements while two were malignant; the latter children received postexcision adjuvant chemotherapy. There was no mortality. At a median follow-up of 4.5 years (6 months to 8 years), 14/15 have had an event-free survival. One immature mediastinal teratoma that recurred locally 7.5 years after the initial operation was excised and adjuvant chemotherapy instituted.
  
  
  CONCLUSIONS
  Extragonadal GCTs in children are uncommon and occasionally present with atypical clinical, radiological and histological features resulting in diagnostic and therapeutic dilemmas.
authors.affiliation: Department of Paediatric Surgery, St. John's Medical College Hospital, St. John's National Academy of Health Sciences, Bangalore, Karnataka, India.
authors.forename: Mainak
authors.initials: M
authors.lastname: Deb
authors.forename: Suravi
authors.initials: S
authors.lastname: Mohanty
authors.forename: Anuradha
authors.initials: A
authors.lastname: Ananthamurthy
authors.forename: Isha
authors.initials: I
authors.lastname: Garg
authors.forename: Kanishka
authors.initials: K
authors.lastname: Das