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Pleuropulmonary blastoma (PPB) is a rare primary malignant tumor in the chest that mainly occurs in children <6 years of age. Vascular extensions are even rarer, approximately 3 % of types II and III PPB, and have fatal complications. The patients of reported cases who had tumor extension to the heart are younger than three years old, whereas in this case, we reported an 11-year-old girl who was of school age. This case report aims to describe a rare case of a type III Pleuropulmonary Blastoma infiltrating the left heart of a school-age girl. An 11-year-old girl presented at an emergency department with two months of progressive dyspnea with malnutrition. A fused mass was found in LA on an echocardiogram along with moderate MR, severe MS, and mild pericardial effusion. CT scan showed a massive pleural effusion with a solid mass in the left lung obstructing the left bronchial tree, accompanied by the expansion of the tumor mass into the left pulmonary vein and LA. Total removal of the tumor was performed, aided by cardiopulmonary bypass. Type III PPB was confirmed histopathologically. PPB is a rare, aggressive tumor that has three types. Various manifestations can occur in line with the presence of metastases. The treatment consists of aggressive surgery and chemotherapy. Because of its poor prognosis, prompt recognition of the involvement of the cardiac chamber and great vessels in type III PPB should be considered before surgery. • Type III Pleuropulmonaryblastoma or purely solid PPB have the least favorable outcomes with a 53 % survival rate as they may present at more advanced age and advanced stage • Type II and III PPB are both aggressive tumors. Surgical resection and systemic chemotherapy are important roles in the treatment. • Radical resection and absence of metastasis are promising and can be done safely with the aid of chemeotherapy and possibly radiotherapy [ABSTRACT FROM AUTHOR]

Extragonadal germ cell tumors at the mediastinum are rare and comprise of 3–4 % of all germ cell tumors. Mixed GCTs can remain asymptomatic for long periods and often present with complications. We present a case of a young male patient with a mediastinal tumor infiltrating the heart and obstructing the right ventricular outflow tract, causing cardiogenic shock. A 16-year-old male came with chief complain of shortness of breath and underwent an echocardiogram which revealed a mass in the right atrium and right ventricle. On CT scan, a solid mass in the mediastinum, expanding and infiltrating the right atrium was found. Our patient underwent surgical treatment. Histopathology results were consistent with mixed germ cell tumor comprised of seminoma, yolk sac, and mature teratoma at the right atrial and mediastinum. The pathogenesis of extragonadal GCTs has been linked to abnormal and/or incomplete migration of the primordial germ cells from the endoderm yolk sac to gonads. Mediastinum GCT can become clinically problematic through its growth patterns, especially its expansive profile, which can cause compression on surrounding mediastinal structures, including major vessels, which in turn diminish blood flow. Overall survival improvement is strongly linked with surgical resection of the tumor, which achieve removal of tumor tissue resistant to chemotherapy and provides sample for histological examination, which helps assessment of pathological response to chemotherapy and planning of further management. The mediastinum is a site of different neoplasia, including germ cell tumors. Despite its low incidence, the diagnosis of a mediastinal mixed germ cell tumor should be considered in young patients with a mediastinal mass. This tumor is aggressive and often infiltrates surrounding structures and metastasis. Physicians must be aware of the difficulties and complications associated with the diagnosis. • Mixed germ cell tumors of the anterior mediastinum are a sporadic and aggressive disease that often invades and infiltrates surrounding structures and metastasis. These tumors can present in a life-threatening condition, such as cardiogenic shock. • These tumors can get big enough to compress on mediastinal structures leading to a medical emergency. • Primary GCT of the mediastinum often has a poor prognosis. • Surgery contributed to long-term survival as part of a multimodal aggressive treatment approach. • A better understanding of this disease's clinical and imaging knowledge is the key to early diagnosis, early intervention treatment, and improved prognosis. [ABSTRACT FROM AUTHOR]