Figure 22-19. A, Axial computed tomography scan of chest shows a large multicystic anterior and middle mediastinum mass. There is also a right-sided pleural effusion. B, Cut surface of the mediastinal tumor shows fibrosis, cystic degeneration, hemorrhage, and necrosis; despite its worrisome appearance, this was a mature teratoma in a 13-year-old male. The pathogenesis of degenerative changes are ischemia and the presence of pancreatic tissue.
than that in postpubertal and adult males. Another large series of pediatric mediastinal nonseminoma-tous germ cell tumors in children and adolescents identified differences in genetic profiles in patients older versus younger than 8 years of age.66 Schneider and colleagues66 analyzed 35 mediastinal germ cell tumors by comparative genomic hybridization and found that all of the pure teratomas had normal profiles. Malignant germ cell tumors in children younger than 8 years had no isochromosome 12 but showed gains of 1q, 3, and 20q and loss of 1p, 4q, and 6q. Patients older than 8 years commonly showed gains in chromosome 12p. Various candidate genes have been identified.70
Thus far, the clinical and morphologic complexity of germ cell tumors extends into the molecular characteristics as well. Future ancillary studies to probe for loss and overexpression of genes appear justified.
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