Background: Germ cell tumors are malignancies arising from gamete precursors usually located in the gonads or more rarely along the midline of the body including the anterior mediastinum. Primary mediastinal germ cell tumors are always of poor prognosis. In lack of validated treatment strategies the protocols of gonadic germ cell tumors are usually applied. Methods: The case of a young male patient is reported who underwent 4 cycles of bleomycin-etoposide-cisplatin and 2 cycles of etoposide-cisplatin primary chemotherapy followed five weeks later by the resection of the residual mass of a primary mediastinal germ cell tumor measuring initially 11 cm of long axis. Results: He was declared healthy after a five-year long relapse-free follow up. Conclusion: Prolonging the advised 4 cycles of chemotherapy and programming the operation to 4-6 weeks after the first day of the last cycle of the chemotherapy seem to be reasonable therapeutic approaches.