• Congcong Ren, Jing Zhao, Lin Kang, Yan Di, Gang Qiu, and Qingxue Wang.
• Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China.
• Medicine (Baltimore). 2021 Oct 29; 100 (43): e27617e27617.

RationaleMediastinal non-seminomatous germ cell tumors (MNSGCTs) are rare malignancies. Chemotherapy followed by surgical resection has been regarded as the standard management, but treatment options for chemotherapy-refractory patients or those with unresectable tumors are limited, resulting in a very poor prognosis.Patient ConcernsAn 18-year-old female presented with symptoms of cough, chest tightness, and shortness of breath for 2 months, and the symptoms gradually worsened.DiagnosisComputed tomography (CT) revealed a large mediastinal mass invading the pericardium and great blood vessels. Serum human chorionic gonadotropin (HCG) and α-fetoprotein (AFP) levels were normal. Histopathological examination of biopsy specimens revealed mixed MNSGCT with embryonal carcinoma and immature teratoma components.InterventionsThe patient achieved complete remission (CR) and long-term survival after multimodal therapy comprising chemotherapy, positron emission tomography/CT (PET/CT)-guided volumetric-modulated arc therapy (VMAT), and anti-angiogenic targeted therapy.OutcomesThe patient was followed up for more than 4 years without recurrence, metastasis, or treatment-related adverse effects.LessonsThe case presented here highlights the importance of multidisciplinary diagnosis and treatment, providing evidence that radiotherapy and anti-angiogenic therapy may play an important role in unresectable or residual tumors after failure of conventional treatments of MNSGCT. Percutaneous biopsy is necessary for diagnosis if the tumor is unresectable, and serum AFP and HCG levels are normal. Additionally, PET/CT is an effective method for evaluation of efficacy and radiotherapy guidance for patients with MNSGCTs.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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