Resection of large mediastinal germ cell tumor in an adolescent

Germ cell tumors (GCTs) are neoplasms that arise from the pluripotent cells of the embryo, typically originating in the gonads. However, in approximately 2% to 5% of cases, they develop in extragonadal locations such as the mediastinum, retroperitoneum, or pineal gland.1 The clinical presentation of primary mediastinal GCTs can vary widely, ranging from incidental detection on imaging studies to severe, life-threatening symptoms, including respiratory distress or cardiovascular compromise. Large intrathoracic masses pose significant challenges both for surgical resection and anesthesia management.