SUDDEN-DEATH DUE TO UNDETECTED MEDIASTINAL GERM-CELL TUMOR

A 32-year old man, apparently asymptomatic, was found dead in his apar tment. Autopsy revealed a large necrotic mediastinal mass with liver a nd occipital brain metastases, the latter having produced acute intrap arenchymal and intraventricular hemorrhage with cerebellar tonsillar h erniation. Histologically, the mediastinal mass and metastases were co nsistent with immature extragonadal teratoma, with malignant transform ation of the intestinal-type epithelium. Undiagnosed neoplasms as caus es of sudden death are quite rare and usually reported in older age gr oups; however, in one study of autopsies in a 25- to 46-year-old age g roup, a significant 3.2% was reported. Germ cell tumors of the mediast inum are the most common extragonadal primary site, accounting for sim ilar to 50%-70% of extragonadal germ cell tumors (EGCTs) and primarily affecting 20- to 35-year-old men. EGCTs are usually symptomatic at th e time of diagnosis, although a large proportion may be asymptomatic. This case represents one the few reported cases of sudden death as a r esult of mediastinal EGCT; it also demonstrates the natural course of this disease and underscores the importance of medicolegal autopsies i n cases of sudden death.