Poorly differentiated carcinoma of the anterior mediastinum in a young male - A diagnostic dilemma

A 22-year-old male with anterior mediastinal tumour had extensive local and metastatic disease at initial presentation. The diagnosis was based on tru-cut biopsy of the primary lesion and fine needle aspiration cytology of the metastatic deposit along with serum tumour marker studies. The biopsy as well as the cytology smears showed features of a poorly differentiated carcinoma, and both serum alpha-foeto-protein and hCG levels were elevated. A diagnosis of malignant mixed germ cell tumour was suggested. The patient achieved complete remission following cis-platin based chemotherapy and is disease free for the last 12 years.