Long‐Term Survival After Desperation Surgery for Primary Mediastinal Non‐Seminomatous Germ Cell Tumor With Rising Alpha‐Fetoprotein

Introduction: Primary mediastinal non-seminomatous germ cell tumors (PMNSGCTs) are rare and aggressive neoplasms that carry a poor prognosis, especially following salvage chemotherapy. In cases of residual tumors with elevated tumor marker levels, desperation surgery may be considered. Case Presentation: A 32-year-old man with PMNSGCT presented with a 100-mm anterior mediastinal mass and elevated alpha-fetoprotein (AFP; 17 000 ng/mL). After induction and salvage chemotherapy, AFP levels decreased to 20 ng/mL but did not normalize, and a 55-mm cystic tumor persisted. Desperation surgery was performed despite an increase in AFP (40 ng/mL) before the operation. The tumor was completely resected, and histopathological examination revealed no viable tumor cells or teratomas. Postoperatively, AFP normalized, and the patient has remained recurrence-free. Conclusion: This case highlights the potential role of desperation surgery in achieving long-term survival in selected patients with PMNSGCT, despite increased levels of tumor markers.