Successful resection of giant mediastinal tumor with growing teratoma syndrome by bilateral transmanubrial approach, clamshell and median sternotomy

A 25-year-old man was initially diagnosed with a giant mediastinal nonseminomatous germ cell tumor. Chemotherapy was administered and the tumor markers were normalized; however, the tumor grew in size (20 cm), invading the left brachiocephalic vein (BCV) and the superior vena cava (SVC). Bilateral transmanubrial approach with median sternotomy and bilateral clamshell thoracotomy was required for the complete resection of the giant tumor with the SVC reconstruction. Bilateral TMA provided the surgical field of view around the bilateral phrenic nerves and bilateral BCVs. Given the final pathological diagnosis of the mature teratoma, this was considered growing teratoma syndrome where surgery is the only treatment option.