Background Malignant mediastinal germ cell tumors are a rare disease and represent only 1% to 4% of all mediastinal tumors. without any evidence of recurrence. Conclusion Primary mediastinal Yolk sac neoplasm represent a unique entity, and as such require specialized management. The diagnosis should be made not only by morphological studies but the patients age and the elevation of serum alpha-fetoprotein should also be considered. The utilization of cisplatin-based chemotherapy is associated with the best chance of a cure for this disease. This should be followed by surgical resection of the residual tumor in the nonseminomatous germ cell tumor. strong class=”kwd-title” Keywords: Mediastinal nonseminomatous germ cell tumors, Complete pathologic response, Cisplatin-based chemotherapy Background Germ cell tumors of extragonadal origin represent only 1% to 5% of all germ cell tumors . The mediastinum represents the most common site of extragonadal primaries (50% to 70%). More than half of mediastinal germ cell tumors are mature teratomas. Among malignant mediastinal germ cell tumors, 40% are seminomas and 60% are nonseminomatous tumors. In spite of modern chemotherapy, the prognosis of mediastinal yolk sac tumors remains poor. The single most important prognostic indicator BIRC2 is whether the tumor mass can be completely excised before or after chemotherapy. We report an extremely rare case of germ-cell tumor localized at the level of the anterior mediastinum, with a complete pathologic response after chemotherapy. Case presentation A 26-year-old Moroccan man, with out a medical or health background, offered a four-month Imatinib Mesylate tyrosianse inhibitor background of upper body stress, dyspnea, and a regular dry coughing for the prior month. A computed tomographic scan from the upper body revealed a cumbersome mediastinal mass, raised after contrast moderately, calculating 10 12cm size (Shape? 1). Open up in another window Shape 1 Computed tomography scan from the upper body: an enormous tumor of mediastinum before treatment. The needle primary biopsy demonstrated a malignant germ cell tumor corresponded to yolk sac tumor. The human being chorionic gonadotropin amounts were within regular range; however the serum degree of alpha-fetoprotein of the patient was raised to 19052?ng/ml. This backed the analysis of a Yolk sac tumor, a uncommon primary tumor inside the mediastinum. Preoperative chemotherapy included 4?cycles of BEP (cisplatin 20?mg/m2?J1-J5; bleomycin 30?mg?J2, J8, J15; etoposide 100?mg/m2?J1-J5) was presented with to the individual having a partial response to chemotherapy (Shape? 2). The medical procedures was after that performed predicated on full excision of most residual anterior mediastinal mass having a full pathologic response. Open up in another window Shape 2 Computed tomography scan from the upper body: incomplete response after 4?cycles of chemotherapy. The individual survived 60?weeks after medical procedures with complete remission without the proof recurrence (Numbers? 3 and ?and44). Open up in another window Shape 3 Computed tomography scan of the chest: there is no evidence of disease 5?months after treatment. Open in a separate window Figure 4 Computed tomography scan of the chest: complete response 5?years after diagnosis. Discussion Extragonadal germ cell tumors account for 1C5% of all germ cell tumors . The most widely accepted theory suggests that extragonadal germ cell tumors arise from Imatinib Mesylate tyrosianse inhibitor primordial germ cells misplaced during their migration to gonads . The mediastinum is the most common site of extragonadal germ cell tumors , constituting 50C70% of all extragonadal germ cell tumors. In adults, extragonadal germ cell tumors account for 15% of primary anterior mediastinal tumors . Mediastinal nonseminomatous germ cell tumors has features that differentiate it from gonadal non Imatinib Mesylate tyrosianse inhibitor seminomatous germ cell tumor, such as an association with Klinefelter syndrome and the frequent development of a hematologic malignancy [5C7]. Mediastinal nonseminomatous germ cell.