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Int J Clin Exp Pathol 2012;5(9):982-990

Case Report
The histogenic origin of melanoma arising in respiratory epithelium of a teratomatous
germ cell tumor of the mediastinum: an enigma unraveled from an unlikely source

Patricia McNab, Brian Quigley, Tania Mendoza, Ardeshir Hakam, Farah Khalil, Mayer Fishman, Soner Altiok

University of South Florida College of Medicine, Tampa, FL, USA; Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and
Research Institute, Tampa, FL, USA; Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.

Received June 19, 2012; Accepted September 24, 2012; Epub October 20, 2012; Published October 30, 2012

Abstract: Mixed germ cell tumors are rare neoplasms that are known to occur in the anterior mediastinum. Characterized by two or more types
of germ cell components, these tumors comprise upwards of 25% of mediastinal germ cell tumors. Even rarer are those harboring somatic-
type malignancies such as carcinoma, sarcoma, and hematopoietic malignancies. To date, however, there are no known cases of melanoma
arising in a malignant mixed germ cell tumor of the anterior mediastinum. We describe the first case of malignant melanoma with spindle and
epithelioid components arising from respiratory epithelium in a mediastinal malignant mixed germ cell tumor of a 32-year-old male. In addition,
we also provide evidence supporting the theory of neuroendocrine cells as the origin of melanoma arising in the respiratory epithelium. This
case emphasizes the need to carefully evaluate all germ cell tumors, not only for a myriad of benign embryological components, but also for
malignancies arising in these components, as they might change the prognosis and patient’s course of treatment. This microscopic approach
should bring to light the diversity of mixed germ cell tumors in addition to somatic malignancies with corresponding biologic potentials.

Keywords: Histogenic origin, melanoma, respiratory epithelium, teratomatous germ cell tumor, mediastinum

Address all correspondence to:
Dr. Soner Altiok
Department of Anatomic Pathology
H. Lee Moffitt Cancer Center & Research Institute
12902 Magnolia Drive, Tampa, FL 33612.
Phone: (813) 745-7665; Fax: (813) 745-6875
E-mail: soner.altiok@moffitt.org