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

boundaries

cranial - thoracic aperture
caudally – diaphragm
dorsally - spine
ventrally - sternum

distribution

see Mediastinum

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':

Stadium	Characteristics
I	macroscopically completely encapsulated, microscopically without capsular invasion
II	macroscopic invasion into surrounding fat tissue or pleura, microscopically capsular invasion
III	macroscopic invasion into surrounding organs (pericardium, lungs, large vessels)
IVA	spread to the pleura or pericardium
IVB	lymphogenic, hematogenous metastases

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.

For more information see Heart tumors.

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

Links

References

DÍTĚ, P.. 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.

Kategorie:Vnitřní lékařství Kategorie:Pneumologie Kategorie:Patologie Kategorie:Chirurgie Kategorie:Onkologie