A 30-year-old man presented with chest pressure, shortness of breath, severe dyspnea on exertion, dysphagia, odynophagia, and a weight loss of 13 kg over a 2-month period. He had undergone orchiectomy 3.5 years earlier for stage 1 testicular seminoma but had been lost to follow-up. Physical Examination: Normal sinus rhythm, no murmurs or gallops. Lungs were clear on auscultation. Radiography: Radiography and CT of the chest revealed a large, posterior mediastinal mass.
On CT, the mass measured 19 cm by 15 cm by 8 cm, displaced adjacent structures, and circumscribed the descending thoracic aorta. Lab results: Laboratory evaluation revealed a human chorionic gonadotropin level of 4 mIU per milliliter (normal value, <3), a lactate dehydrogenase level of 1400 U per liter (normal range, 140 to 270), and a normal alpha-fetoprotein level. What tests should be done next? Is biopsy required at…
