title: Successful resection of a giant mediastinal non-seminomatous germ cell tumor showing fluorodeoxyglucose accumulation after neoadjuvant chemotherapy: report of a case.
abstract: A 32-year-old man presented with a mediastinal non-seminomatous germ cell tumor showing fluorodeoxyglucose (FDG) accumulation (maximum standardized uptake value = 22.21) and extremely elevated blood alpha-fetoprotein (AFP) level (9203.0 ng/ml). The patient underwent 4 cycles of neoadjuvant chemotherapy (cisplatin, bleomycin, and etoposide), which normalized the AFP level and reduced the tumor size, allowing complete resection without a support of extracorporeal circulation. Despite preoperative positron emission tomography revealing increased FDG uptake in the residual tumor (maximum standardized uptake value = 3.59), the pathologic evaluation revealed that no viable germ cell tumor cells remained. We believe FDG uptake should not be used as a criterion for surgical resection after neoadjuvant chemotherapy. It is appropriate to resect the residual tumor regardless of FDG uptake after induction chemotherapy if a tumor is resectable and the AFP level normalizes.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Takada
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Morodomi
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Okamoto
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Fujishita
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kitahara
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Shimamatsu
authors.forename: Mikihiro
authors.initials: M
authors.lastname: Kohno
authors.forename: Daigo
authors.initials: D
authors.lastname: Kawano
authors.forename: Noriko
authors.initials: N
authors.lastname: Hidaka
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Nakanishi
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D020360:Neoadjuvant Therapy; D009373:Neoplasms, Germ Cell and Embryonal / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18