Conclusions

This case highlights the importance of timely diagnosis and coordinated multidisciplinary management in patients with PMGCTs presenting with vascular and cardiac complications. Surgical reconstruction of the SVC using an expanded polytetrafluoroethylene (ePTFE) prosthesis has been reported to provide immediate and durable relief of symptoms associated with SVC obstruction, with low surgical morbidity, including in selected patients with unresectable malignancy. The use of neoadjuvant chemotherapy allowed for tumor response prior to complex resection, while surgical reconstruction of the SVC enabled complete management of the vascular involvement. This case emphasizes that even advanced mediastinal germ cell tumors with invasion or compression of major thoracic structures may be successfully treated through individualized planning involving oncology, thoracic surgery, cardiac surgery, radiology, and critical care teams. Early recognition of compressive symptoms and rapid escalation to multidisciplinary care are essential to improving outcomes in these complex presentations.