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case_images: (A-D) Whole-body PET-CT showed a left anterior mediastinal soft tissue shadow, an uneven increase in radioactive uptake (SUVmax = 4.5), and no obvious abnormalities in other organ tissue examinations. (E) A chest X-ray showed a left anterior mediastinal tumor with illuminated edges. (F-H) Chest CT showed a large mass of soft tissue density in the left anterior upper mediastinum, with lobulated edges and uneven internal density, and mild to moderate enhancement of the solid part of the edge on enhanced scanning.
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case_images: The results showed that the 18F-fluoro-deoxyglucose metabolism of the left anterior mediastinal mass was increased, and there were no abnormalities in the examination of other organs and tissues ( Figures 1A-D ). A chest X-ray and a chest CT showed a large left anterior mediastinal mass; the maximum measurement was approximately 72 mm x 49 mm, and the remaining preoperative examination results were normal ( Figures 1E-H ).
case_images: (A) The tumor seen during surgery. (B-D) The completely removed mediastinal tumor after surgery and the internal conditions after tumor incision.
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case_images: Figure 2A ). Finally, under the premise of resecting part of the upper left lung lobe, we successfully and completely removed this large tumor. The tumor was actually measured to be approximately 110 mm x 60 mm x 45 mm in size, resembling a kidney, dark red and grayish yellow, hard in texture, and with solid gray-white tissue inside ( Figures 2B-D ).
case_images: Trends in the patient's HCG-beta levels before and after surgery.
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case_images: We found that HCG-beta decreased significantly to 111.11 mIU/mL on postoperative day 1 and to 11.2 mIU/mL on postoperative day 6 ( Figure 3 ).
case_images: (A, B) Histologic features of seminoma with large tumor cells, round, polygonal appearance, deep nuclear staining, round foam nuclei, pathological mitotic images, and lymphocyte infiltration of the interstitium were observed (H&E, magnification x50 and x400). (C-F) Immunohistochemistry of tumor cells showed strong expression of AFP (low+), CD117 (+), ki-67 (+), and PLAP (+) (magnification x400). (G-I) Immunohistochemistry of tumor cells showed negative results for CD99 (-), CK-pan (-), and LCA (-) (magnification x400).
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case_images: T 1.75 nmol/L (normal 6.07-27.10 nmol/L), E2, FSH, PRL, and UGLU results are normal. The final pathological diagnosis was mediastinal seminoma involving the lungs ( Figures 4A, B ). AFP (low+), PLAP (+), and ki-67 (80%+) ( Figures 4C-I ). A week after the operation, the man recovered well and was discharged from the hospital.