Mediastinal Tumors

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Mediastinal Tumors

• Ana M. Wright

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The Mediastinum
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Anterior Superior 54

• Thymus Gland
• Aortic Arch
• SVC Superior Vena Cava
• Lymph Node
• Parathyroid Gland
• Ectopic Thyroid Tissue

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Middle 20

• Pericardium
• Heart
• Great Vessels
• Trachea
• Trachea Bifurcation
• Main Bronchi
• Phrenic Nerve
• Hilar Lymph Node

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Posterior 26

• Esophagus
• Vagus nerves
• Sympathetic Chain
• Thoracic duct
• Thoracic desending
• Aorta
• Azygos
• Hemiazygosvein
• Paravertebral Lymphnode

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Subdivision of mediastinum as seen on cross
section

• anterior mediastinum (1)
• middle mediastinum (2)
• posterior mediastinum (3)

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Children

• Posterior Mediastinum
• Most often benign
• 2/3 of tumors symptomatic

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Adult

• Anterior Mediastinum
• Often Malignant
• Ages 30 50
• 1/3 of tumors are symptomatic

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Malignancy

• All tumors 25
• Per Section
• Anterior Superior 59
• Posterior 16
• Middle 16

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Etiology of Tumors

• Lympathic tumors
• 45 in Children Anterior
• Adult Second more common anterior
• Found in mediastinum
• Immunoblastic T-cell
• Immunoblastic B-cell
• Follicular center cell
• Lymphoblastic
• Hodgkin Lymphoma (nodular sclerosing type)-

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Malignant Tumors Invasion Structure

• Tracheobronchial tree and lungs
• Esophagus
• Superior Vena Cava
• Pleura and Chest Wall
• Intrathoracic nerves

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Primary Mediastinal Tumors

• 10 of mediastinal masses
• Thymic carcinoma
• Neuroendocrine carcinoma
• Germ-cell tumors (GCT)
• Lymphoma
• Neurogenic tumors
• Parathyroid Tumors
• Mesenchymal Tumors

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Symptoms

• Cough
• Shortness of Breath
• Chest pain
• Fever
• Chills
• Night Sweats
• Hemoptysis
• Hoarseness

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Diagnostic

• Chest X-Rays
• CT ( Computed Tomography)
• MRI
• CT guided needle biopsy
• Mediastinoscopy with biopsy
• Radionuclide Scanning

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Treatment

• Varies according location of tumors
• Common is Surgical resection
• Thymic Cancer Surgery follow by radiation/or
  chemotherapy
• Exception
• Lymphatic Tumors
• Mesenchimal Tumors (Rhabdomyosarcoma)

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Prognosis

• Varies depending on type of tumors and
• resection.
• Benign tumors excellent prognosis
• Malignant tumors depends on the type

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Malignant Tumors Prognosis

• Mediastinal Lymphoma
• Malignant Mesenchymal Tumors
• Mediastinal Parathyroid Carcinoma
• Intrathoracic goiter with Occult Malignancy

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• Bibliography
• 1. Bacha, E. A. M.D., A.R. Chapelier, M.D. PhD.,
  P. Macchiarini, M.D., E. Fadel, M.D., and P.G.
  Dartevelle, M.D. 1998. Surgery for Invasive
  Primary Mediastinal Tumors. The Society of
  Thoracic Surgeons. Elsevier Science Inc. 1998
  66 234-239.
• 2. Eggerstedt, J. M., M.D. 2003 Lymphomas,
  Endocrine, Mesenchymal, and Other Rare Tumors of
  the Mediastinum. online Retrieved 7/19/2004.
  http//www.emedicine.com/med/topic3455.htm.
• 3. Graccone, G., R. Musella, O. Betetto, M.
  Donadio, and A. Calciati. 1985.
  Cisplatin-Cntaining Chemotherapy in the Treatment
  of Invasive Thymoma. U.S. Department of Health
  and Human Services Cancer Treatment Report, June
  1985 69695-697.
• 4. Hartmann, J.T., C.R. Nichols, J.P. Droz, A.
  Horwich, A. Gerl, S.D. Fossa, J. Beyer, J. Pont,
  K Fizazi, L. Einhorn, L. Kanz, C. Bokemeyer.
  2000. Hematologic Disorders Associated With
  Primary Mediastinal Nonseminomatus Germ Cell
  Tumors. 2000. U.S. Department of Health and
  Human Services Journal of the National Cancer
  Institute 9254-61.
• 5. Kawakami, M., K. Ito, K. Yoshimura, and H.
  Tanaka. 2003. A Case of Mediastinal Goiter.
  Auris Nasus Larynx 31(2004) 183-187
  www.elservier.com/locate/anl

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• 6. Kuchiki, H., J. Yasuda, T. Kayama, Y.
  Murakami, and T. Sekiya. 1999. Detection of DNA
  Abnormalities by Arbitrarily Primed PCR
  Fingerprinting Amplification of MDM2 Gene in a
  Mediastinum Fibrosarcoma. Biochemical and
  Biophisical Research Communication. 1999. 258
  271-277.
• 7. Macchiarini, P. and Ostertag, H. 2004.
  Uncommon Primary Mediastinal Tumours. The Lancet
  Oncology Vol. 5 February 2004 107-118. online.
  http//oncology.thelancet.com
• 8. Mediastinal Tumors. 2004. Thirayosts Page.
  online Retrieved 7/16/2004. http//www.geocities
  .com/thirayost2/web_health/mediatinal.html.
• 9. Medline Plus 2004. Medical Encyclopedia
  Mediastinal Tumor online Retrieved 7/21/2004.
  http//www.nlm.nih.gov/medlineplus/ency/article/00
  1086.thtm.
• 10.Meral, M., M. Akgun, H. Kaynar, A. Mirici, M.
  Gorguner, L. Saglam, and F. Erdogan. 2003.
  Mediastinal Lymphadenopathy due to Mycobacterial
  Infection. Short Communication. Jpn. J. Infect.
  Dis. 2004. 57124-126.
• 11. University of Pensylvania Health System.
  2004. online Retrieved 7/16/2004.
  http//www.pennhealth.com.lency/article/001086.htm
  .