Silent Symptoms, Timely Diagnosis Save 10-Year-Old from Rare 900g Germ Cell Tumor at Rainbow Children’s Hospital
What began as seemingly routine, recurrent chest infections in a 10-year-old schoolboy turned into a life-threatening diagnosis, highlighting how silent and easily overlooked certain pediatric conditions can be. Delayed recognition of underlying symptoms allowed a rare 900g mediastinal germ cell tumor to grow undetected, occupying a significant portion of the child’s chest. However, timely intervention and advanced multidisciplinary care at Rainbow Children’s Hospital, Chennai, led to the successful diagnosis and complete removal of the tumor, giving the child a new lease on life.
The child initially presented with recurrent respiratory infections. At Rainbow Children’s Hospital, a multidisciplinary team of specialists assembled for further evaluation. An ultrasound (USG)-guided core needle biopsy revealed a mediastinal germ cell tumour, with extremely elevated alpha-fetoprotein (AFP) levels of 2,68,000 (normal <10), strongly indicating malignancy. The child underwent five cycles of chemotherapy over a period of three months, administered once every three weeks, as part of standard treatment to reduce the tumor burden. Despite this, the tumor continued to occupy more than 75% of the chest cavity, necessitating definitive surgical management. Given its critical location, surrounded by the heart and major blood vessels, both conventional and minimally invasive surgical approaches were considered high risk.
Speaking on the case, Dr. Dhinesh Balaji J D, Consultant – Pediatric Surgeon & Pediatric Urologist, Rainbow Children’s Hospital, Chennai, said, “In a complex surgical intervention, the team performed an open chest surgery via sternotomy, an approach typically used in cardiac procedures to safely access and remove the centrally located tumor. This enabled better visualization and protection of vital blood vessels, ensuring complete removal without the risk of tumor spillage. The tumor, weighing almost 1kg (approximately 850–900 grams), was successfully excised. Post-surgery, the child required ventilator support for just 24 hours, resumed oral intake the next day, and was discharged within four days. A follow-up scan conducted 6–8 weeks later confirmed no residual tumor.”
Dr. Nandhini G, Senior Consultant – Pediatric Surgeon & Pediatric Urologist, Rainbow Children’s Hospital, Chennai, added, “Managing such a case requires seamless collaboration across specialties. Our team brought together expertise in pediatric surgery, oncology, critical care, and anesthesia to ensure the best possible care. It is immensely gratifying to see the child recover well and return to normal life, and to witness the relief and happiness of the family.”
Mr. Gunasekhar C, Cluster Head, Rainbow Children’s Hospital, Chennai, said, “At Rainbow Children’s Hospital, our focus is on early diagnosis and delivering the right treatment at the right time. This case reflects our commitment to combining advanced medical expertise with a child-centric approach. Seeing the child recover fully and become tumor-free is a testament to the strength of our multidisciplinary care model.”
Mediastinal germ cell tumors are rare and often develop silently, as germ cells present during early development can occasionally be misplaced outside the reproductive organs and grow abnormally over time. Though uncommon, such tumors can become life-threatening if not detected early. Doctors emphasize that persistent chest infections or unexplained breathing difficulties in children should not be ignored, and timely evaluation can be critical in preventing complications.
The multidisciplinary team of specialists comprised Dr. Dhinesh Balaji J D, Consultant – Pediatric Surgeon & Pediatric Urologist; Dr. Nandhini G, Senior Consultant – Pediatric Surgeon & Pediatric Urologist; Dr. Senthil Ganesh K, Consultant – Pediatric Surgeon & Urologist; Dr. Karthik Narayanan R, Senior Consultant – General Pediatrics, PICU & Emergency; and Dr. Sathish Chander, Lead Consultant Anesthesiologist, all of whom played a key role in the successful completion of this remarkable surgery
