# Long‐Term Survival After Desperation Surgery for Primary Mediastinal Non‐Seminomatous Germ Cell Tumor With Rising Alpha‐Fetoprotein

## TL;DR

A rare aggressive tumor in the chest was successfully treated with surgery after chemotherapy failed, leading to long-term survival.

## Contribution

This case demonstrates that desperation surgery can lead to long-term survival in PMNSGCT patients with elevated tumor markers.

## Key findings

- Desperation surgery led to complete tumor resection and normalization of alpha-fetoprotein levels.
- The patient remained recurrence-free after surgery despite elevated tumor markers before the operation.

## Abstract

Primary mediastinal non‐seminomatous germ cell tumors (PMNSGCTs) are rare and aggressive neoplasms that carry a poor prognosis, especially following salvage chemotherapy. In cases of residual tumors with elevated tumor marker levels, desperation surgery may be considered.

A 32‐year‐old man with PMNSGCT presented with a 100‐mm anterior mediastinal mass and elevated alpha‐fetoprotein (AFP; 17 000 ng/mL). After induction and salvage chemotherapy, AFP levels decreased to 20 ng/mL but did not normalize, and a 55‐mm cystic tumor persisted. Desperation surgery was performed despite an increase in AFP (40 ng/mL) before the operation. The tumor was completely resected, and histopathological examination revealed no viable tumor cells or teratomas. Postoperatively, AFP normalized, and the patient has remained recurrence‐free.

This case highlights the potential role of desperation surgery in achieving long‐term survival in selected patients with PMNSGCT, despite increased levels of tumor markers.

Desperation surgery may facilitate long‐term survival in selected patients with primary mediastinal non‐seminomatous germ cell tumors, despite elevated tumor marker levels after chemotherapy. Careful patient selection and complete resection are essential.