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[edit | edit source]
- boundaries
- cranial - thoracic aperture
- caudally – diaphragm
- dorsally - spine
- ventrally - sternum
- distribution
see Mediastinum
Epidemiology[edit | edit source]
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[edit | edit source]
- 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[edit | edit source]
- Superior vena cava syndrome
- cyanosis;
- neck swelling (Stokes collar);
- formation of venous collaterals;
- congestion in cerebral vessels causing a headache.
Types of mediastinal tumors[edit | edit source]
- 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[edit | edit source]
- Anteroposterior + lateral chest X-ray;
- CT, US, contrast examination of the esophagus, angiography;
- scintigraphy 131I;
- mediastinoscopy (biopsy).
Treatment[edit | edit source]
- Ch. surgical; stent;
- thymomas radio- + chemosensitive (cisplatin).
Tumors of the thymus[edit | edit source]
They can originate from epithelial cells (thymic carcinoma), lymphocytes (lymphoproliferation), or from chromaffin cells (carcinoid).
Thymomas[edit | edit source]
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[edit | edit source]
- Often accidentally found on a chest X-ray;
- myasthenic syndrome;
- aplasia red lines;
- hypogammaglobulinemia;
- associated autoimmune diseases – lupus erythematosus, rheumatoid arthritis.
Diagnostics and Treatment[edit | edit source]
- 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[edit | edit source]
- encapsulated forms - 90%
- invasive forms - 50%
- stage IV – 11%
Other thymic tumors[edit | edit source]
- 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[edit | edit source]
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[edit | edit source]
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[edit | edit source]
Related articles[edit | edit source]
References[edit | edit source]
- 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.
- BENEŠ, Jiří. Studijní materiály [online]. ©2004–2008. [cit. 2013]. <http://www.jirben2.chytrak.cz/>.
Kategorie:Vnitřní lékařství
Kategorie:Pneumologie
Kategorie:Patologie
Kategorie:Chirurgie
Kategorie:Onkologie
