Submit Manuscript | http://medcraveonline.com Abbreviations: YST, Yolk sac tumor; EC, Embryonal carcinoma; CC, Choriocarcinoma; CGCTs, Combined germs cell tumors; SVC, Superior Vena Cava; NSGCT, Non-Seminomatous Germ Cell Tumors; AFP, α-fetoprotein; β-HCG, beta human chorionic gonadotropin; BEP regimen, bleomycin etoposide cisplatin; TIP, paclitaxel ifosfamide cisplatin Introduction The posterior mediastinum presents a tendency to develop metastatic tumours especially gonadic ones, because of the lymphatic drainage of the testes and the thoracic aorta in the posterior mediastinal, whereas anterior mediastinal space characterized by tumour growth of primary aetiology. 1 The regions of the rare presence of primary seminoma is the pineal body, the mediastinum and the retroperitoneum. The mediastinal region is the most common site of seminoma. The latter is in the anterior mediastinum, involves predominantly young males and corresponds to 25-30% of malignant mediastinal germ cell tumours. 2–6 The thymus gland is often the primary hosts of mediastinal seminoma. 7,8 Even if there are supporters of thymic genetic origin of the primary seminoma, the latest theory professes ectopic seminoma of a tumour originating in the gonads. 9 Additionally, yolk salk tumour is a germ cell tumour which behave as a mixed tumour within other tumours of the same category as teratoma (35%), or as an extremely rare pure solitary one like in our case. 10,11 Two interesting rare cases presented in this report which concern two categories of germ cell tumours: mediastinal seminoma and pure yolk sac tumour. 1 st Case presentation The 1st case we report is of a 22-year-old Caucasian male, who was admitted to our hospital with a 3-days history of progressive dyspnea on exertion, neck swelling, fatigue, persistent chest pain, pyrexia, and a cough that was occasionally productive of blood. The physical examination revealed a heart rate of 115 beats per minute (Sinus Rhythm), a respiratory rate of 25 breaths per minute and superfcial vascular distention over the neck. Laboratory studies revealed elevated serum α-fetoprotein (AFP) (5380 IU/ml) and D-dimer (481ng/ml). A chest X-ray in the poster - anterior view, upon admission, depicted a suggestive right upper mediastinal mass (Bild 1). Radiography was followed by contrast-enhanced CT scan that revealed a large, homogeneous mediastinal mass crossing into the anterior mediastinum and compressing – encasing the superior vena cava. It also showed signs of thrombosis of the left brachiocephalic vein, and multiple flling defects at the left pulmonary artery indicating embolism. Subcarinal lymphadenopathy, as well as enlarged lymph nodes of the right hilum was present (Bild’s 2-5). On median sternotomy, a large non resectable tumor was observed involving the in nominate vein and the superior vena cava (Bild 6). Great care was taken to remove as much tumor mass as possible. To decompress the MOJ Clin Med Case Rep. 2019;9(3):68‒74. 68 ©2019 Daliakopoulos et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Primary malignant Germ-Cell tumors of the anterior mediastinum in adults. Report of two rare cases and review of the literature Volume 9 Issue 3 - 2019 Stavros I Daliakopoulos, Maria Stergianni, GrigoriosKaragkiouzis, Antonella Koutela, Dimitrios Pappas, Christos Tsakalakis, Charalampos Martinos Metropolitan General Hospital, Mesogeion Avenue 264, Greece Correspondence: Stavros I Daliakopoulos, Metropolitan General Hospital, Mesogeion Avenue 264, 15562 Cholargos, Greece, Tel +306947429559, Email Received: May 12, 2019 | Published: June 18, 2019 Abstract Introduction: Malignant germ-cell tumors are usually located in the gonads. Extragonadal germ-cell tumors are extremely rare and are typically located in midline structures and, especially, the anterior mediastinum. They are divided into seminomas and non- seminomatous germ cell tumors. The former is a radiosensitive tumor that can be successfully treated by surgery and radiation. The latter is a very rare category including: yolk sac tumor (YST), embryonal carcinoma (EC), choriocarcinoma (CC) and combined germs cell tumors (CGCTs). These tumors with relatively unknown clinical behavior are uncommon neoplasm of the mediastinum and only sporadic cases have been documented in the literature. Case presentation: We report two male patients referred to our team with huge bulky tumors of the anterior mediastinum, infltrating into adjacent anatomical structures for consultation and management. At the time of admission one of the patients presented with grossly edematous upper extremities and engorged cervical veins suggesting Superior Vena Cava (SVC) syndrome. The patients were treated surgically at frst instance, for different medical reasons each, the unusual neoplasms with the different biologic behavior were totally excised or not, according to each case surgical demands and the systemic manifestations of the neoplasms were reversed. Conclusion: Malignant germ cell tumors are suspected among anterior mediastinal tumors affecting male patients of around 20 years old. Tumor markers must be investigated and tissue histology should be diagnosed for specimens obtained by mediastinoscopy or anterior mediastinotomy. In case of Non- Seminomatous Germ Cell Tumors (NSGCT) or a-Fetoprotein and/or humane Chorion gonadotropin producing seminoma, the frst choice remains chemotherapy. Means for surgical decision making are based only on dramatically worsening clinical indicators of SCV syndrome because initial debulking surgery is rarely useful. Keywords: anterior mediastinum, yolk sac tumor, primary malignant germ-cell tumors MOJ Clinical & Medical Case Reports Case Report Open Access