Mediastinal tumours

Mediastinal tumors are relatively rare, but their incidence is gradually increasing. They are often asymptomatic, mostly benign.

Anatomy

Borders

• cranial – thoracic inlet
• caudal – diaphragm
• dorsal – spine
• ventral – sternum

Epidemiology

The incidence of medisatinal tumors in the Czech Republic in 1998 was 1.1/100,000 residents. They mostly appear when patients are in their 30s and 40s. Of the total number, only one third show malignant behavior.

Clinical picture

• Asymptomatic (up to 90% benign), often an accidental X-ray finding
• cough
• shortness of breath
• recurrent respiratory infections
• dysphagia
• chest pain or pressure
• Horner's syndrome
• systemic symptoms: myasthenia gravis , hypertension , hypercalcemia , etc.

Clinical signs common to all mediastinal tumours

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

Types of mediastinal tumours

• Anterior mediastinum: thymomas, thyroid tumors + parathyroid glands, teratomas, germ cell carcinomas and lymphomas
• 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, ECHO, esophageal contrast examination, angiography
• scintigrafy
• mediastinoscopy (biopsy)

Therapy

• Mainly surgical; SVCS → stent
• Thymoma-radio + chemosensitive (cisplatin)

Thymic tumours

They can come from epithelial cells (thymic carcinoma), from lymphocytes (lymphoproliferative), or from chromaffin cells (carcinoid).

Thymoma

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

Clinics

• often an accidental finding on chest x-ray
• myasthenic syndrome
• pure red line aplasia
• hypogammaglobulinemia
• associated autoimmune diseases - lupus erythematosus, rheumatoid arthritis

Diagnostics and therapy

Diagnostics

• Chest skiagram
• CT
• MRI
• histopathological examination - transcutaneous or transbronchial puncture biopsy
• there is no TNM classification, we evaluate according to Masaoka:

Stage	Characteristics
I	macroscopically completely encapsulated, microscopically without capsular invasion
II	macroscopic invasion of the surrounding adipose tissue or pleura, microscopically invasive invasion
III	macroscopic invasion of surrounding organs (pericardium, lungs, large vessels)
IVa	sowing on the pleura or pericardium
IVb	lymphogenic, hematogenous metastases

Therapy

• surgery – complete resection possible only in stage I and II
• radiotherapy
• chemotherapy – cisplatin, ifosfamide (neoadjuvant or palliative)
• combination

Prognosis

• encapsulated forms – 90 %
• invasive forms – 50 %
• stage IV – 11 %

Other thymic tumours

• carcinoid - aggressive growth, metastasis to the liver and bones, paraneoplastic syndrome (Cushing's syndrome), often part of MEN-I or MEN-II
• germinal tumors - rarely seminomas, non-seminomas
• malignant lymphomas - rare

Heart tumours

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

Tumours in the posterior mediastinum

They are manifested by the so-called Mediastinal syndrome:

• irritant cough, dyspnoea, stridor induced by tracheal compression
• dysphagia from esophageal oppression
• neuralgia and root pain
• Horner syndrome in sympathetic disorders
• signs of spinal cord compression

Mesenchymal tumors

• lipoma (liposarcoma)
• rhabdomyoma (rhabdomyosarcoma)
• fibroma (fibrosarcoma)

Neurogenic tumors

• malignant schwannoma
• neurofibrosarcoma
• neuroblastoma
• chemodectoma

Source

References

• DÍTĚ, P., et al. Vnitřní lékařství. 2. edition. Praha : Galén, 2007. ISBN 978-80-7262-496-6.

• KLENER, Pavel. Klinická onkologie. 1. edition. Praha : Galén, 2002. 686 pp. pp. 391–395. ISBN 80-7262-151-3.

• BENEŠ, Jiří. Studijní materiály [online]. ©2004–2008. [cit. 2013]. <http://www.jirben2.chytrak.cz/>.