History
The clinical manifestations of mediastinal seminomas depend on their histology, size, and rate of growth. Seminomas like the mature teratomas have a slow growth rate and are often discovered incidentally during the workup of another disorder. Once the lesion grows to be larger than 20-50 mm, it may generate symptoms such as a dry hacking cough, fever, night sweats, dyspnea, a pressurelike sensation, or vague chest pain.
In most benign cases, seminomas are discovered on a routine chest radiograph. Patients with malignant seminomas usually present with symptoms of compression or invasion of surrounding structures; uncommonly, systemic effects of the tumors may be apparent. Constitutional symptoms (eg, pain, weight loss, fever, fatigue, and dyspnea) have been described. Occasionally, mediastinal adenopathy and superior vena cava syndrome (SVCS) may occur. [7]
Unlike nonseminomas, most seminomas have a localized effect and remain intrathoracic. They are rarely associated with other syndromes.
Physical Examination
Physical findings, again, depend on the size and location of the lesion. In cases where the lesion is small, there may be no physical findings. If the tumor is large and compresses the superior vena cava, the patient may present with facial plethora and enlargement of the veins in the face and neck area. If the lesion is compressing the bronchus, the patient may present with hemoptysis, pneumonia, or both.
In all patients with a mediastinal seminoma, the scrotum must be examined; a painless solid mass may be noted.
Complications
The following complications may occur from a mediastinal seminoma:
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Tracheal compression and even tracheomalacia
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SVCS
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Erosion into the bronchus causing massive hemoptysis
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Recurrent nerve compression and palsy
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Contrast-enhanced axial CT scan shows ill-defined anterior mediastinal mass with irregular borders that is infiltrating mediastinal fat. CT-guided needle biopsy revealed mediastinal seminoma.
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Histopathology of seminoma.
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Chest radiograph shows large mediastinal seminoma causing deviation of trachea.
