Intravascular EBUS-TBNA for diagnosis of primary mediastinal seminoma invading the superior vena cava: a case report

Background Mediastinal seminoma is a very rare extragonadal malignant germ cell tumor that is often misdiagnosed. Case presentation A 27-year-old male presented with dyspnea. Imaging demonstrated a mass invading the right upper lobe, extending to the anterior mediastinum, and invading the superior vena cava (SVC). Computed tomography (CT)-guided biopsy showed necrotizing granulomas, and empiric antituberculosis therapy was initiated. The absence of clinical and radiological improvement after four months necessitated diagnostic re-evaluation via endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). EBUS-TBNA biopsies from the mass invading the SVC through an intravascular approach were performed without significant adverse events and yielded adequate tissue. Rapid on-site assessment and histopathology confirmed seminoma. Following diagnosis, the patient received chemotherapy with subsequent clinical and radiological improvement during follow-up. Conclusions Intravascular EBUS-TBNA is a safe, minimally invasive technique for diagnosing primary mediastinal Seminoma invading the SVC.