Suggest Treatment For Mediastinal Seminoma

Posted on Fri, 5 May 2017

Question: Im a 29 year old male diasgnosed with mediastinal seminoma. I went through chemo but the lymph nodes in my chest havent decreased in size as much as they should have. My oncologist is stumped and is wondering if the pathology from the biopsy on my left supraclavicular lymph node was correct. What do you think?

Answered by Dr. Deepak Sundriyal (48 minutes later)

Brief Answer:
Hello. I would like to see the scans as well

Detailed Answer:
Hello dear. I have gone through the details. The biopsy report confirms it as seminoma. However , as the seminomas are very much chemo sensitives, its unusual that it doesnot respond. I would like tyo see the ct scan prior to chemo as well as after chemo. Also i would like to know the tumor markers done prior to chemo which include, AFP, BHCG, and LDH reports. Please let me know te chemo details too, drug used and no of chemo cycles.
Thanks and regards
Feel free to ask further

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Deepak Sundriyal (1 hour later)

My tumor markers were always normal except for slightly elevated LDH.
I received 3xBEP chemo starting on Dec 12, 2016 and ending on XXXXXXX 30, 2017(my last round of bleomycin was skipped).
As you can see from the ct scan reports, some mediastonal lymph nodes have decreased in size while some have increased(ive received 2 ct scans since the completion of chemo). Could this be sarcoidosis?
My oncologist is sending me for a PET scan and potentially a biopsy of the lymph nodes in my chest after that. The only biopsy i received was on my left supraclavicular lymph node, which decreased in size considerably even before i began chemo and is completley gone now.

Answered by Dr. Deepak Sundriyal (2 hours later)

Brief Answer:
Hello. Biiopsy is the only answer

Detailed Answer:
Hello dear. I have gone through the reports. So The scan findings are not very suggestive of disease but the final call will be by biopsy. A PETCT can be done as it will show metabolic activity in the nodes and then biopsy can be done easily from active nodes. Moreover, LDH can be done again and it will help in making a diagnosis. Again sarcoidosis and tuberculosis can be a possibility and that too will be ascertained by biopsy only. Please go for the tests.
Thanks and regards

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Deepak Sundriyal (12 hours later)

I definitely will. One last thing: what makes you think the scan results arent indicitive of disease?

Answered by Dr. Deepak Sundriyal (55 minutes later)

Brief Answer:
Hello. Because chemotherapy is highly effective

Detailed Answer:
Hello dear.

It's because chemoradiation is highly effective in seminoma and the residual nodes can be just necrotic.

Thanks and regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee