Classification and therapy of germ cell tumors in anterior mediastinum

A total of 12 cases of anterior mediastinal germ cell tumors observed in our laboratory for 30 years from 1957 to 1986 were classified into 6 types according to the additionally modified Dixon and Moore's classification and the therapies and prognoses of each type were investigated and the following results were obtained.1. There are various nomenclatures used to describe germ cell tumors in anterior mediastinum and their classification has not yet been established, therefore our classification seemed practically useful in the surgical clinical field.2. In the cases of Type II (embryonal carcinoma pure, or with seminoma) and VI (yolk sac tumor) prognoses were extremely resistant to treatment whereas that of Type III was satisfactory.3. AFP and hCG used as a tumor marker were very useful as an indicator for chemotherapeutic effectiveness and the recurrence of postectomy, and the immunohistochemical study of ectomized tumors was inevitable which was useful for postoperative classification and therapy.4. Prolonged survival can be expected by combining radiotherapy with operation in the treatment of Type III. Furthermore, it is desirable to additionally perform chemotherapy after operations when a positive picture was found immunohistochemically.5. For the patients with germ cell tumors producing AFP, adjuvant surgery was applied after chemotherapy using cisplatin as a main agent, then the prognostic convalescence of the difficult anterior mediastinal germ cell tumors could be predicted.