A 1 9-year-old male patien t who is in rem ission after receivi ng LJ cycles of BEP chemo-therapy for primary mediastinal yolk sac germ cel l tumor presen ts with fatigue 3 mon ths after his last cycle. Laboratory evaluation shows leukocyte count of LJ3.500/JLL. hemoglobin 7.6 g/dl. and platelet count 7.000/JLL. The peripheral blood smear is shown below. Flow cytometry of the peripheral blood cells express CD 1 3 . CD3 3. CDLJ 1. and CD6 1 .

What statement best describes the time interval and median survival of hematologic malignancies associated with primary mediastinal germ cell tumors?
- Onset is usually 1 to 2 years and median survival 3 years
- Onset is usually within 6 months and median survival is less than 6 months
- Onset is usually within 6 months and median survival is less than 6 months
- Onset is usually 1 to 2 years and median survival less than 6 months
B. The median time between the diagnosis of the tumor and the diagnosis of the hemato-logic malignancy is 5 months, and prognosis of these patients is extremely poor, with a median sur-vival of 1 month (range, 0 to 32) (N Engl J Med. 1990;322:1425-1429).
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