Tumors of the mediastinum

Tumors of the mediastinum are relatively rare, but their incidence has a gradually increasing tendency. They are often asymptomatic, mostly benign.

Anatomical notes
see Mediastinum
 * boundaries
 * cranial - thoracic aperture
 * caudally – diaphragm
 * dorsally - spine
 * ventrally - sternum
 * distribution

Epidemiology
The incidence of mediastinal tumors in the Czech Republic was 1.1/100,000 inhabitants in 1998. They most often appear between the ages of 30 and 50. From the total number, only one-third show malignant behavior.

Causes and symptoms

 * Asymptomatic (up to 90% benign); often accidentally found on X-ray;
 * cough;
 * stuffiness;
 * recurrent respiratory infection;
 * dysphagia;
 * pressure to pain in the chest;
 * Horner syndrome;
 * systemic symptoms: myasthenia gravis, hypertension, hypercalcemia etc.

Clinical symptoms common to all tumors of the mediastinum

 * Superior vena cava syndrome
 * cyanosis;
 * neck swelling (Stokes collar);
 * formation of venous collaterals;
 * congestion in cerebral vessels causing a headache.

Types of mediastinal tumors

 * Anterior mediastinum: thymomass, thyroid tumors + parathyroids, teratomass, germ carcinomas and lymphomass;
 * middle mediastinum: primary and secondary heart tumors, benign and malignant mesenchymal tumors, malignant lymphomas, bronchiogenic cysts;
 * posterior mediastinum: neurogenic tumors (neurofibroma, neurosarcoma, ganglioneuroma, neuroblastoma, paraganglioma).

Diagnostics

 * Anteroposterior + lateral chest X-ray;
 * CT, US, contrast examination of the esophagus, angiography;
 * scintigraphy 131I;
 * mediastinoscopy (biopsy).

Treatment

 * Ch. surgical; stent;
 * thymomas radio- + chemosensitive (cisplatin).

Tumors of the thymus
They can originate from epithelial cells (thymic carcinoma), lymphocytes (lymphoproliferation), or from chromaffin cells (carcinoid).

Thymomas
They occur equally in adulthood in both sexes. The incidence in the Czech Republic in 1998 was 0.1/100,000. Malignant variants can metastasize to the lungs and nodes and grow into surrounding structures.

Causes and Symptoms

 * Often accidentally found on a chest X-ray;
 * myasthenic syndrome;
 * aplasia red lines;
 * hypogammaglobulinemia;
 * associated autoimmune diseases – lupus erythematosus, rheumatoid arthritis.

Diagnostics and Treatment

 * Diagnostics
 * Skiagram of the chest;
 * CT;
 * MR;
 * histopathological examination – transcutaneous or transbronchial puncture biopsy;
 * there is no TNM classification, we evaluate according to Masaoka':
 * Treatment
 * surgery – complete resection possible only for stage I and II;
 * radiotherapy;
 * chemotherapy - cisplatin, ifosfamide (neoadjuvant or palliative);
 * combination.

Prognosis

 * encapsulated forms - 90%
 * invasive forms - 50%
 * stage IV – 11%

Other thymic tumors

 * Carcinoid – aggressive growth, metastasis to liver and bone, paraneoplastic syndrome (Cushing's syndrome), often part of MEN-I or MEN-II;
 * germ tumors – rarely seminomas, non-seminomas;
 * malignant lymphomas - rarely.

Heart Tumors
Heart tumors are divided into primary, which are very rare, and secondary, which are more common.

Tumors in the posterior mediastinum
They are manifested by the so-called posterior mediastinal syndrome:
 * Irritating cough, shortness of breath, stridor induced by tracheal compression;
 * dysphagia from esophageal oppression;
 * neuralgia and root pain;
 * Horner's syndrome in sympathetic disorder;
 * signs of spinal cord compression.
 * mesenchymal tumors
 * lipoma (liposarcoma)
 * rhabdomyoma (rhabdomyosarcoma)
 * fibroma (fibrosarcoma)
 * neurogenic tumors
 * malignant schwannoma
 * neurofibrosarcoma
 * neuroblastoma
 * chemodectoma

Related articles

 * Mediastinum
 * Lung tumors