Mediastinal Tumors and Cysts.ppt

Mediastinal Tumors and CystsIntroduction SilentSilent in early phase in early phase Mainly cause Mainly cause pressure symptomspressure symptoms Incidentally discovered by routine x-raysIncidentally discovered by routine x-rays Specific disease entities according to anSpecific disease entities according to anatomical,and embryologic originatomical,and embryologic origin 50%malignant in children where as 25%50%malignant in children where as 25%in adultsin adults Metastatic tumorMetastatic tumor is the most common tu is the most common tumormor PainPain CoughCough HemoptysisHemoptysis SVC syndromeSVC syndrome HoarsenessHoarseness DyspneaDyspnea HornerHorners syndromes syndrome DysphagiaDysphagia Pleural effusionPleural effusion StridorStridor Myathenia GravisMyathenia Gravis Phrenic nerve palsyPhrenic nerve palsy ChylothoraxChylothoraxSymptoms and Signs Diagnosis Chest PA&LateralChest PA&Lateral Bucky filmBucky film Chest CTChest CT FluoroscopyFluoroscopy BronchoscopyBronchoscopy EsophagogramEsophagogram NABNAB Isotope ScanningIsotope Scanning AngiographyAngiography ThoracotomyThoracotomy VATSVATS MedistinoscopyMedistinoscopyCommon Diseases of the MediastinumThymoma Anterior and Superior mediastinum Most common(20%)of mediastinal tumor in adults but rarely seen in children 2/3 is malignant Equal frequency in males and females 30 50 yrs Various Classification:Lymphocytic,Epithelial,Spindle Cell 50%are asymptomatic Associated diseases :MG(35%),PRCA,DiGeroge SD,Carcinoid,Eaton-Lambert,agammaglobulinemia,myocarditis,thyrotoxicosis,etcThymoma(Staging)Stage I:contained within an intact capsule Stage II:extension through the capsule to surrounding fat,pleura,pericardium Stage III:Intrathoracic metastasis Stage IV:Extrathoracic MetastasisThymoma(Treatment)Stage I:Surgical resection Recurrence 2-12%Stage II&III:Surgery+Radiotherapy Stage IV :Multimodality Induction chemotherapy,surgery+post op Radiotherapy 5-year Survival 12 54%,not affected by the presence of Myasthenia GravisThymomaThymomamassCa+Thymus Lymphoma Metastatic is most common 5-10%is mediastinal primary Second moost common Anterior Mediastinal Mass in Adults Malignant Hodgkins Dx:Mediastinoscopy,thoracotomy NAB:Usually not confirmatoryHodgkins Lymphoma“mediastinal widening”Germ Cell Tumors Anterior Mediastinal location Mainly in late teens 15%of Ant.Med.Tumors in Adults,24%in children 1/5 is Malignant Cystic Teratoma(Dermoid Cyst)vs.Solid tumor(Teratoma)Solid tumor:1/3 malignant Radiosensitive Teratoma,Malignant teratoma,Seminoma(dysgerminomas)TeratomaTeratomaTeratomaTeratomaSubsternal Thyroid Tissues Develops from cervical goiter or intrathoracic remnants Can be diagnosed without biopsy by Radioactive iodine scan No treatment unless symptomatic,usually pressure symptomsRtrosternal GoiterNeurogenic Tumors Posterior mediastinal locationPosterior mediastinal location 1/5 of mediastinal tumor1/5 of mediastinal tumor Originate in neural crestOriginate in neural crest Ganglioheuroma:most common in thGanglioheuroma:most common in the textbooke textbook Neurilemmoma Neurilemmoma most common in Ko most common in Korea:rea:“Dumb bell TumorDumb bell Tumor”,neural shea,neural sheath originth originPoosterior Mediastinal Tumor(Neurillemmoma)“Dumb-bell”TumorNeurilemmoma(Schwannoma)Para-gangliomaMesenchymal Tumors Lipoma,Fibroma,MesotheliomaLipoma,Fibroma,Mesothelioma Superior or Anterior mediastinal locatiSuperior or Anterior mediastinal locationon Diagnosis with CT scanDiagnosis with CT scan May cause HypoglycemiaMay cause HypoglycemiaMediastinitis Acute Acute:endoscopy complication,Boe:endoscopy complication,Boerhaaverhaaves SD,operation,esophageal rs SD,operation,esophageal rupture,median sternotomyupture,median sternotomy ChronicChronic:Tbc,histoplasmosis,silicos:Tbc,histoplasmosis,silicosis,fibrosing mediastinitisis,fibrosing mediastinitisFibrosing Mediastinitis 20-40 years20-40 years Cough,Dyspnea,or HemoptysisCough,Dyspnea,or Hemoptysis Most common cause of Most common cause of Benign SVC syndrBenign SVC syndromeome Almost always remote Almost always remote HistoplasmosisHistoplasmosis Plain X-rays may be normal or only minimaPlain X-rays may be normal or only minimal changesl changes Partially calcified Mass on CT is diagnosticPartially calcified Mass on CT is diagnosticFibrosing MediastinitisF/29 with SVC Syndrome by HistoplasmosisF/29 with SVC Syndrome by HistoplasmosisFibrosing MediastinitisF/29 with SVC Syndrome by HistoplasmosisF/29 with SVC Syndrome by HistoplasmosisPneumomediastinum Spontaneous:mainly in young male Spontaneous:mainly in young male adultsadults Hamman signHamman sign Present along the Left sternal borderPresent along the Left sternal border Substernal pain,cough,Dyspnea,DySubsternal pain,cough,Dyspnea,DysphagiasphagiaPneumomediastinumBenign Cysts Most Common in Middle mediastinumMost Common in Middle mediastinum 20%of mediastinal masses20%of mediastinal masses Less common in KoreaLess common in Korea Usually asymptomaticUsually asymptoma