Computed Tomography Manifestations of Mediastinal Endodermal Sinus Tumors in Childhood: 5 Case Report and Literature Review

Reports describing the computed tomography (CT) manifestations of mediastinal endodermal sinus tumor (EST) in childhood are rare. To improve the diagnostic accuracy and facilitate differential diagnosis, we reviewed the imaging and pathological characteristics of mediastinal ESTs in childhood. Five cases of mediastinal ESTs confirmed by pathological and immunohistochemical analyses were retrospectively analyzed. CT examinations were essential to confirm ESTs. Of 5 lesions, 3 occurred in the right anterior, 1 in the right posterior, and 1 in the left anterior mediastinum. The CT values of the plain scans ranged from 29 HU to 38 HU. Punctate calcification was noted in 1 case. Arterial phase CT showed obvious enhancement, with a CT value of 20 HU. In the delayed phase, enhancement was progressively strengthened. Pleural effusions and oppressive atelectasis were found in all 5 cases. ESTs seemed to easily encroach on the other side of the mediastinum and may have involved the chest muscle, with local elevation of the chest wall, but no rib erosion. EST usually manifested as a large solitary mass originating from the anterior mediastinum on the right. Contrast-enhanced CT examination and alpha-fetoprotein (AFP) testing are essential for accurate diagnosis.