Shortness of breath can be due to pleural effusion or massive mediastinal mass. If there is recurrence, spread to parenchymal organs such as liver, kidneys, or brain is common. Alpha fetoprotein and beta HCG levels - These markers are often highly elevated in mediastinal germ cell tumors, which constitutes an important differential diagnosis in males. Diffuse infiltrate consisting of large cells. Clear cells are common.
Fibrosis occurs variably in some areas of the tumor.
B-cell receptor gene rearranged. Performance status should be noted, as it is an important prognostic indicator. Routine labs including serum LDH and serum Beta-2 microglobulin. CT scan chest, abdomen and pelvis Extension to the pleura, pericardium, and even chest wall is common. Invasion of liver, kidneys, and peripheral lymph nodes is more common at the time of recurrence.