{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T22:55:56Z","timestamp":1788994556643,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Malignant mediastinal tumors are a group representing some of the most demanding oncological challenges for early, multi-level, and successful management. The timely identification of any suspicious clinical symptomatology is urgent in achieving an accurate, staged histological diagnosis, in order to follow up with an equally detailed medical therapeutic plan (interventional or not) and determine the principal goals regarding efficient overall treatment in these patients. We report a case of a 24-year-old male patient with an incident-free prior medical history. An initial chest X-ray was performed after the patient reported short-term, consistent moderate chest pain symptomatology, early work fatigue, and shortness of breath. The following imaging procedures (chest CT, PET-CT) indicated the presence of an anterior mediastinal mass (meas. ~11 cm \u00d7 10 cm \u00d7 13 cm, SUV: 8.7), applying additional pressure upon both right heart chambers. The Alpha-Fetoprotein (aFP) blood levels had exceeded at least 50 times their normal range. Two consecutive diagnostic attempts with non-specific histological results, a negative-for-malignancy fine-needle aspiration biopsy (FNA-biopsy), and an additional tumor biopsy, performed via mini anterior (R) thoracotomy with \u201csuspicious\u201d cellular gatherings, were performed elsewhere. After admission to our department, an (R) Video-Assisted Thoracic Surgery (VATS) was performed, along with multiple tumor biopsies and moderate pleural effusion drainage. The tumor\u2019s measurements had increased to DMax: 16 cm \u00d7 9 cm \u00d7 13 cm, with a severe degree of atelectasis of the Right Lower Lobe parenchyma (RLL) and a pressure-displacement effect upon the Superior Vena Cava (SVC) and the (R) heart sinus, based on data from the preoperative chest MRA. The histological report indicated elements of a combined, non-seminomatous germ-cell mediastinal tumor, posthuberal-type teratoma, and embryonal carcinoma. The imminent chemotherapeutic plan included a \u201cBEP\u201d (Bleomycin\u00ae\/Cisplatin\u00ae\/Etoposide\u00ae) scheme, which needed to be modified to a \u201cVIP\u201d (Cisplatin\u00ae\/Etoposide\u00ae\/Ifosfamide\u00ae) scheme, due to an acute pulmonary embolism incident. While the aFP blood levels declined, even reaching normal measurements, the tumor\u2019s size continued to increase significantly (DMax: 28 cm \u00d7 25 cm \u00d7 13 cm), with severe localized pressure effects, rapid weight loss, and a progressively worsening clinical status. Thus, an emergency surgical intervention took place via median sternotomy, extended with a complementary \u201cT-Shaped\u201d mini anterior (R) thoracotomy. A large, approx. 4 Kg mediastinal tumor was extracted, with additional RML and RUL \u201cen-bloc\u201d segmentectomy and partial mediastinal pleura decortication. The following histological results, apart from verifying the already-known posthuberal-type teratoma, indicated additional scattered small lesions of combined high-grade rabdomyosarcoma, chondrosarcoma, and osteosarcoma, as well as numerous high-grade glioblastoma cellular gatherings. No visible findings of the previously discovered non-seminomatous germ-cell and embryonal carcinoma elements were found. The patient\u2019s postoperative status progressively improved, allowing therapeutic management to continue with six \u201cTIP\u201d (Cisplatin\u00ae\/Paclitaxel\u00ae\/Ifosfamide\u00ae) sessions, currently under his regular \u201cfollow-up\u201d from the oncological team. This report underlines the importance of early, accurate histological identification, combined with any necessary surgical intervention, diagnostic or therapeutic, as well as the appliance of any subsequent multimodality management plan. The diversity of mediastinal tumors, especially for young patients, leaves no place for complacency. Such rare examples may manifest, with equivalent, unpredictable evolution, obliging clinical physicians to stay constantly alert and not take anything for granted.<\/jats:p>","DOI":"10.3390\/curroncol32080423","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T14:05:47Z","timestamp":1753711547000},"page":"423","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Multi-Level Oncological Management of a Rare, Combined Mediastinal Tumor: A Case Report"],"prefix":"10.3390","volume":"32","author":[{"given":"Vasileios","family":"Theocharidis","sequence":"first","affiliation":[{"name":"Thoracic Surgery Department, \u201cTheageneio\u201d Cancer Hospital, 54639 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2102-766X","authenticated-orcid":false,"given":"Thomas","family":"Rallis","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department, \u201cTheageneio\u201d Cancer Hospital, 54639 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apostolos","family":"Gogakos","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department, \u201cTheageneio\u201d Cancer Hospital, 54639 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Paliouras","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department, \u201cTheageneio\u201d Cancer Hospital, 54639 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achilleas","family":"Lazopoulos","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department, \u201cTheageneio\u201d Cancer Hospital, 54639 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meropi","family":"Koutourini","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department, \u201cTheageneio\u201d Cancer Hospital, 54639 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myrto","family":"Tzinevi","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department, \u201cTheageneio\u201d Cancer Hospital, 54639 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Vildiridi","sequence":"additional","affiliation":[{"name":"Second Department of Medical Oncology, \u201cTheageneio\u201d Cancer Hospital, 54639 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prokopios","family":"Dimopoulos","sequence":"additional","affiliation":[{"name":"Second Department of Medical Oncology, \u201cTheageneio\u201d Cancer Hospital, 54639 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Kasarakis","sequence":"additional","affiliation":[{"name":"Second Department of Medical Oncology, \u201cTheageneio\u201d Cancer Hospital, 54639 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5211-4814","authenticated-orcid":false,"given":"Panagiotis","family":"Kousidis","sequence":"additional","affiliation":[{"name":"Pathology Department, \u201cTheageneio\u201d Cancer Hospital, 54639 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Nikolaidou","sequence":"additional","affiliation":[{"name":"Pathology Department, \u201cTheageneio\u201d Cancer Hospital, 54639 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paraskevas","family":"Vrochidis","sequence":"additional","affiliation":[{"name":"ENT Department, General Hospital of Serres, 62100 Serres, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Mironidou-Tzouveleki","sequence":"additional","affiliation":[{"name":"First Laboratory of Pharmacology, Medical School, \u201cAristotle\u201d University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Barbetakis","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department, \u201cTheageneio\u201d Cancer Hospital, 54639 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.jtho.2021.10.010","article-title":"The 2021 WHO Classification of Tumors of the Thymus and Mediastinum: What Is New in Thymic Epithelial, Germ Cell, and Mesenchymal Tumors?","volume":"17","author":"Marx","year":"2022","journal-title":"J. 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