CRA80 RARE AND AGGRESIVE: MEDIASTINAL YOLC SAC TUMORS COMPLICATED BY SUPERIOR VANE CAVA SYNDROME – A CASE SERIES

Fadhil el Naser, Sabrina Ermayanti, Afriani Afriani

Departement of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Andalas / Dr. M Djamil General Hospital, Padang, Indonesia

Introduction
Mediastinal yolk sac tumor is a rare and aggressive subtype of non-seminomatous germ cell tumors, predominantly affecting young males. These tumors often present with a poor prognosis and can lead to complications like Superior Vena Cava Syndrome (SVCS).

Case Report
This case series presents three male patients, aged 21-22 years, diagnosed with mediastinal yolk sac tumors complicated by SVCS. All patients presented with progressively worsening shortness of breath, aggravated by physical activity and exacerbated in the supine position. Physical examination revealed venous distention in the neck and face, indicating SVCS. Imaging studies, including chest radiographs and contrast-enhanced CT scans, showed massive pleural effusion and a mediastinal mass compressing the superior vena cava. Transthoracic biopsy confirmed the diagnosis of mediastinal yolk sac tumor in all cases. Initial management included supportive care with dexamethasone and furosemide to reduce SVCS symptoms, followed by chemotherapy with the BEP (Bleomycin, Etoposide, Platinum based) regimen for two patients. One patient died before chemotherapy could be started.

Discussion
Mediastinal yolk sac tumors are aggressive and can lead to SVCS, which significantly worsens prognosis. Symptoms of SVCS, such as facial and neck swelling, difficulty breathing, and venous distention, were evident in all patients. Imaging, including chest radiographs and CT scans, is crucial in confirming the presence of mediastinal masses and assessing the extent of SVCS. While chemotherapy with the BEP regimen remains the standard treatment for non-seminomatous germ cell tumors, the prognosis remains poor. In this series, the median overall survival was only 45 days.

Conclusion
Mediastinal yolk sac tumors complicated by SVCS present significant clinical challenges and have a poor prognosis. Early diagnosis, prompt management of SVCS, and a multidisciplinary approach to treatment are essential for improving outcomes. However, despite aggressive treatment, the overall survival remains low, as demonstrated in this case series.

Keywords: germ cell tumors, mediastinal yolk sac tumor, Superior Vena Cava Syndrome.