Centers of Excellence

The Lung Center

Germ Cell Tumors

As a fetus develops, cells form in eggs in the ovaries or sperm in the testicles. Rarely, these cells travel to other parts of the body and grow into germ cell tumors. Germ cell tumors may be either cancerous (malignant) or non-cancerous (benign) and may occur in the chest, abdomen or brain. Germ cell tumors that form outside the testes or ovaries are known as extragonadal germ cell tumors. Benign extragonadal germ cell tumors are called benign teratomas. These tumors are usually diagnosed with imaging such as CT scans combined with blood tests but may also require a surgical biopsy for analysis. Treatment usually requires a combination of chemotherapy and surgery.

The Lung Center at Brigham and Women’s Hospital (BWH) uses the most current diagnostic methods and offers proven treatments for patients with germ cell tumors of the mediastinum, including minimally invasive surgical techniques aided by video and robotic technology. We are the surgical team for Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), an exceptional collaboration between two world-class medical centers.

Germ Cell Tumors Topics

Types of Germ Cell Tumors

Extragonadal germ cell tumors can be subdivided into:

  • Seminomas
  • Nonseminomas are divided by cell type:
    • Choriocarcinomas
    • Embryonal carcinomas
    • Mixed tumors
    • Teratocarcinomas
    • Yolk sac carcinomas
Risk Factors for Germ Cell Tumors

Risk factors for developing extragonadal germ cell tumors of the mediastinum include:

  • Male
  • Age 20 or older
  • Klinefelter syndrome
Symptoms of Germ Cell Tumors

While not everyone with these tumors has symptoms, the following symptoms may be associated with extragonadal germ cell tumors:

  • Chest pain
  • Breathing problems
  • Cough
  • Fever
  • Headache
  • Change in bowel habits
  • Fatigue
  • Difficulty walking
  • Trouble with vision
Diagnosis of Germ Cell Tumors

Your BWH thoracic surgeon will likely conduct the following tests and procedures to diagnose extragonadal germ cell tumors:

  • Physical exam and medical history
  • Chest X-ray
  • Serum tumor marker test, a blood sample examined to measure the amounts of substances or tumor markers released into the blood by organs, tissues, or tumor cells in the body. The following three tumor markers detect extragonadal germ cell tumors:
    • Alpha-fetoprotein (AFP)
    • Beta-human chorionic gonadotropin (β-hCG)
    • Lactate dehydrogenase (LDH)
  • CT scan, a series of detailed pictures inside the body, taken from different angles by a computer linked to an X-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
  • Position emission tomography (PET scan) uses a small amount of radioactive glucose injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Metabolically active tumor cells can show up brighter in the picture because they take up more glucose than normal cells do. This may indicate malignancy, although infection or inflammation may also appear brighter on a PET scan.
  • Biopsy, the removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The type of biopsy depends on where the extragonadal germ cell tumor is found.
    • Excisional biopsy: The removal of an entire lump of tissue.
    • Incisional biopsy: The removal of part of a lump or sample of tissue.
    • Core biopsy: The removal of tissue using a wide needle.
    • Fine-needle aspiration (FNA) biopsy: The removal of tissue or fluid using a thin needle.
Treatment for Germ Cell Tumors

Surgery

Patients who have benign teratomas or who have tumors remaining after chemotherapy or radiation therapy may need to have surgery in order to remove these tumors completely. At BWH, our thoracic surgeons are experts in the use of minimally invasive surgical techniques such as video-assisted thoracic surgery (VATS) and robotic-assisted mediastinal tumor resection, alternatives to open chest surgery.

  • Video-assisted thoracic surgery (VATS) is a minimally invasive procedure that involves the insertion of a thoracoscope (a tiny camera) and surgical instruments into small incisions in the chest. Lung resection for cancer often requires a large thoracotomy incision with spreading of the ribs. VATS lobectomy uses small incisions without any spreading of the ribs. A camera is used to assist the dissection of sensitive blood vessels and lung structures. Minimally invasive mediastinal surgery allows better maneuverability, visibility and control and the tiny incisions result in less post-operative pain and scarring.
  • Robotic-assisted mediastinal tumor resection, a minimally invasive procedure like a VATS, utilizing a computer-controlled device that moves, positions, and manipulates surgical tools based on the surgeon's movements. Brigham and Women’s Hospital uses the da Vinci® surgical robot to remove masses in the mediastinum, a confined space that is difficult to access.

Non-Surgical Cancer Treatments

  • Radiation therapy uses high-energy rays to kill or shrink cancer cells. Radiation is often used in conjunction with chemotherapy before surgery to shrink the tumor, or after to treat the margin of the resection bed. The Radiation Oncology service at DF/BWCC uses the most advanced equipment and techniques to deliver radiation to cancerous areas, while minimizing exposure to normal tissues.
  • Chemotherapy Chemotherapy at DF/BWCC uses anticancer drugs to kill cancer cells throughout the entire body. Chemotherapy is often used before or after surgery or alone in the most advanced cases. The purpose is to shrink the tumor so it can be surgically removed. Chemotherapy is often used in conjunction with radiation.
  • Biological therapy DF/BWCC use biological drugs in addition to or instead of chemotherapy to help shrink or kill cancer cells. These drugs, when available for specific cancers, may have fewer side effects and can be taken orally.
What You Should Expect

When you become a patient of The Lung Center you will meet many members of the team who will carefully review your medical history and studies. In addition, you will receive a thorough diagnostic examination, after which you will receive a recommendation for a therapy tailored just for you based on your specific diagnosis.

Multidisciplinary Care

Germ cell tumor patients benefit from the wide range of specialists at The Lung Center, including thoracic surgeons, thoracic oncologists, pulmonologists, cardiovascular medicine physicians and thoracic imaging experts. They work in close collaboration with the Mediastinal Tumors Program; this collaboration ensures comprehensive diagnosis and targeted treatment for patients.

Any recommended surgery will be performed by an experienced, board-certified surgeon in collaboration with a treatment team including nurses and physician assistants, all of whom specialize in taking care of patients with germ cell tumors.

Resources

Go to our online health library to learn more about thoracic diseases and tests.

Visit the Kessler Health Education Library in the Bretholtz Center where patients and families can access computers and knowledgeable staff.

Access a complete directory of patient and family services.

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