Nous rapportons l'observation d'un jeune homme de 36 ans traite au centre d'oncologie Ibn-Rochd de Casablanca pour un seminome primitif du mediastin avec metastases revele par une symptomatologie faite de toux, dyspnee, tumefactions laterocervicales, douleurs rachidiennes et troubles de la marche. Le bilan initial objective un elargissement mediastinal important avec pleuresie droite et des metastases vertebrales, les marqueurs tumoraux etaient normaux. Le diagnostic de seminome a ete confirme apres examen anatomopathologique et immunohistochimique des adenopathies cervicales. Le traitement a consiste en une chimiotherapie type BEP et une radiotherapie lombaire, mediastinale et sus-claviculaire. La reponse apres quatre cures de chimiotherapie et radiotherapie a ete estimee a 25 %, le patient est decede dans un tableau de detresse respiratoire cinq mois apres le debut du traitement.
In this study, the case has been reported of a 36-year old male who was treated at the Ibn Rochd Oncology Center in Casablanca for a primary mediastinal seminoma revealed by a symptomatology including cough, dyspnea, laterocervical swelling, rachidial pain and gait disorder. The preliminary investigation showed significant mediastinal enlargement with a right pleuritis and vertebral metastases; tumor markers were normal. The diagnosis of seminoma was confirmed by pathological and immunohistochemical analysis of the cervical adenopathy. Disease management consisted of BEP/cisplatin type chemotherapy and lumbar, mediastinal, and supraclavicular radiotherapy. The response after four courses of combined chemo-/radiotherapy was estimated at 25%, but the patient died from respiratory failure five months after the initiation of treatment.