Mediastinal Tumors and Cysts.ppt

Mediastinal Tumors and Cysts,Sung Chul Hwang,M.D.Dept.of Pulmonary and Critical Care MedicineAjou University School of Medicine,Introduction,Silent in early phaseMainly cause pressure symptomsIncidentally discovered by routine x-raysSpecific disease entities according to anatomical,and embryologic origin50%malignant in children where as 25%in adultsMetastatic tumor is the most common tumor,PainCoughHemoptysisSVC syndromeHoarsenessDyspneaHorners syndrome,DysphagiaPleural effusionStridorMyathenia GravisPhrenic nerve palsyChylothorax,Symptoms and Signs,Diagnosis,Chest PA&LateralBucky filmChest CTFluoroscopyBronchoscopyEsophagogram,NABIsotope ScanningAngiographyThoracotomyVATSMedistinoscopy,Common Diseases of the Mediastinum,Thymoma,Anterior and Superior mediastinumMost common(20%)of mediastinal tumor in adults but rarely seen in children2/3 is malignantEqual frequency in males and females 30 50 yrsVarious Classification:Lymphocytic,Epithelial,Spindle Cell50%are asymptomaticAssociated diseases:MG(35%),PRCA,DiGeroge SD,Carcinoid,Eaton-Lambert,agammaglobulinemia,myocarditis,thyrotoxicosis,etc,Thymoma(Staging),Stage I:contained within an intact capsuleStage II:extension through the capsule to surrounding fat,pleura,pericardiumStage III:Intrathoracic metastasisStage IV:Extrathoracic Metastasis,Thymoma(Treatment),Stage I:Surgical resection Recurrence 2-12%Stage II&III:Surgery+RadiotherapyStage IV:Multimodality Induction chemotherapy,surgery+post op Radiotherapy5-year Survival 12 54%,not affected by the presence of Myasthenia Gravis,Thymoma,Thymoma,mass,Ca+,Thymus,Lymphoma,Metastatic is most common5-10%is mediastinal primarySecond moost common Anterior Mediastinal Mass in AdultsMalignant Hodgkins Dx:Mediastinoscopy,thoracotomyNAB:Usually not confirmatory,Hodgkins Lymphoma,“mediastinal widening”,Germ Cell Tumors,Anterior Mediastinal locationMainly in late teens 15%of Ant.Med.Tumors in Adults,24%in children1/5 is MalignantCystic Teratoma(Dermoid Cyst)vs.Solid tumor(Teratoma)Solid tumor:1/3 malignantRadiosensitiveTeratoma,Malignant teratoma,Seminoma(dysgerminomas),Teratoma,Teratoma,Teratoma,Teratoma,Substernal Thyroid Tissues,Develops from cervical goiter or intrathoracic remnantsCan be diagnosed without biopsy by Radioactive iodine scanNo treatment unless symptomatic,usually pressure symptoms,Rtrosternal Goiter,Neurogenic Tumors,Posterior mediastinal location1/5 of mediastinal tumorOriginate in neural crestGanglioheuroma:most common in the textbookNeurilemmoma most common in Korea:“Dumb bell Tumor”,neural sheath origin,Poosterior Mediastinal Tumor(Neurillemmoma),“Dumb-bell”Tumor,Neurilemmoma(Schwannoma),Para-ganglioma,Mesenchymal Tumors,Lipoma,Fibroma,MesotheliomaSuperior or Anterior mediastinal locationDiagnosis with CT scanMay cause Hypoglycemia,Mediastinitis,Acute:endoscopy complication,Boerhaaves SD,operation,esophageal rupture,median sternotomyChronic:Tbc,histoplasmosis,silicosis,fibrosing mediastinitis,Fibrosing Mediastinitis,20-40 yearsCough,Dyspnea,or HemoptysisMost common cause of Benign SVC syndromeAlmost always remote HistoplasmosisPlain X-rays may be normal or only minimal changesPartially calcified Mass on CT is diagnostic,Fibrosing Mediastinitis,F/29 with SVC Syndrome by Histoplasmosis,Fibrosing Mediastinitis,F/29 with SVC Syndrome by Histoplasmosis,Pneumomediastinum,Spontaneous:mainly in young male adultsHamman signPresent along the Left sternal borderSubsternal pain,cough,Dyspnea,Dysphagia,Pneumomediastinum,Benign Cysts,Most Common in Middle mediastinum20%of mediastinal massesLess common in KoreaUsually asymptomaticBronchogenic cyst(32%),pericardial cyst(35%),enteric cyst(12%),thymic cyst,and thoracic duct cyst,Pericardial Cyst,Thin-walled,mesothelial cell lining most common in Right C-P angle Simple cysts are almost always asymptomaticRare cardiac impingement,Pericardial Cyst(1),Pericardial Cyst(2),Bronchogenic Cysts,30-60%of all mediastinal cystsLined by ciliated respiratory epitheliumMay contain cartilages or mucousCommunicate with tracheobronchial treesMay become infectedWheezing,dyspnea,recurrent pulmonary infections,Bronchogenic Cyst,Bronchogenic Cyst,Aortic Aneurysm,Thymolipoma,Paratracheal Lymphadenopathy,Paratracheal Lymphadenopathy with Tracheal Compression,Paratracheal Lymphadenopathy,Paratracheal Malignant Lymphadenopathy,