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Clinical Features: Progressive dysphagia (first for solids and then for liquids) and weight loss are typical features. Excessive salivation, aspiration pneumonia, anaemia and lassitude are late effects. may erode into a bronchus to establish an esophago-bronchial fistula, perforate into the mediastinum, or infiltrate the recurrent laryngeal nerves to cause hoarseness. Stimulates recurrent laryngeal nerve vomiting Can also irritate the posterior surface of carina (bifurcation of trachea) Diagnosis: Dysphagia, major presenting complaint complaints of dysphagia (usually progressive) warrants esophagoscopy to rule out carcinoma. Diagnosis based on esophageal biopsy Double-contrast barium swallow: shows irregular filling defect or localized stricture of the esophagus. Endoscopy required to establish a tissue diagnosis and determine the extent of longitudinal intramural tumor spread. entire esophagus is visualized, and brush cytology plus biopsy tissue samples are obtained for histologic analysis. EUS EUS-guided fine-needle aspiration (FNA) further increases diagnostic yield. can determine the anatomic location and enlargement of the mediastinal, perigastric, or celiac lymph nodes.
CT scan can determine anatomic location and enlargement of the mediastinal, perigastric, or celiac lymph nodes. PET(positron emission tomography) Staging: - after esophagoscopy and biopsy, staging of the tumor for determining which therapeutic option TNM staging: T (tumor) indicates the progressive degree (1- 4) of invasion of the into the esophageal wall. N stands for nodal involvement M represents distant metastasis.
Stomach.2nd and 3rd burns without perforation are managed by supportive care. colon. cardiac risk. 1st burns are observed. Clinical features: oral pain. Treatment: Immediate verification of the etiologic agent. Indications and contraindications: general debility. multisystem dysfunction.can improve esophageal obstruction in most patients in 4 to 7 days. chemotherapy. infection. or combination of these techniques Surgical Treatment: non-metastatic disease. or metastatic disease limit the patient’s health. complication of 2nd or 3rd degree esophageal burns is stricture formation. malnutrition.Treatment: surgery. Caustic perforation requires immediate esophageal and/or gastric resection.8 weeks after initial injury. chest and abdominal radiographs and then esophagoscopy. drooling. . its microscopic extensions. invasion of a vital structure. hematemesis. a passage must be established for alimentary continuity. corrosives and bleaches. and with surveillance for late strictures. Relieve of dysphagia Chemotherapy: Chemotherapy is most often used preoperatively alone or in combination with radiation therapy to treat micrometastases and reduce the tumor size to improve resectability. Reconstruction After Esophagectomy: After partial removal or esophagus or complete esophagectomy. liver failure. No surgery indication-chemotherapy is combined with radiation therapy for primary treatment to achieve palliation and possibly improve survival. and jejunum used as esophageal substitutes most often utilizing the posterior mediastinum or retrosternal routes. Caustic Injury of the esophagus: rare condition and occurs most commonly in young children accidentally swallowing household caustics. which develops 3. Mild early stricture formation sometimes responds satisfactorily to a single dilatation. radiation. with/without stent placement or gastrostomy. and inability or refusal to swallow. Radiation Therapy: goal is to destroy the tumor. requires radiologic and endoscopic evaluation to assess the injury. and other local sites of metastases has low morbidity. esophagectomy can be performed in patients who are able to tolerate the procedure.
Diagnosis: Endoscopy is an essential step in the evaluation of GERD. occurring in small amounts in healthy individuals. Esophagoscopy is indicated to evaluate the severity of esophagitis and possibility of associated carcinoma. major clinical consequences of GERD are esophagitis and its complications ( benign stricture or Barrett’s esophagus). . after ingestion of liquids. Diagnosis: Barium swallow shows uniform esophageal dilatation with a distal tapering (“beak”) secondary to failure of the LES to relax. Treatment: Because the derangement in esophageal motor function does not return to normal. and increased LES resting pressure. H2 blockers. characterized by dysfunctional or absent esophageal peristaltic waves. and Motor Disorders should be excluded because this determination will affect the operative approach. The indications for surgical therapy have changed with the advent of proton pump inhibitors. motility agents. and later after ingestion of solids. In early stages of achalasia. or pathological. impaired relaxation of the LES on receipt of the food bolus. A significant amount of information about the function of the esophageal body and LES may be obtained from stationary esophageal manometry. regurgitation. Manometric criteria of achalasia are failure of the LES to relax and lack of progressive peristalsis throughout the length of the esophagus. treatment is purely palliative. Treatment: antacids. Both nonsurgical/surgical treatments of achalasia are directed toward relieving the obstruction caused by the nonrelaxing LES.Achalasia: most common motility disorder of the esophageal body and lower esophageal sphincter(LES). patient notes a sticking sensation. Gastroesophageal Reflux Disease Gastro-esophageal reflux refers to the process of reflux of stomach contents into the esophagus. Diverticula. Clinical features: symptoms includes dysphagia. Dysphagia Tumor. and proton pump inhibitors. observed in abnormally large quantities in symptomatic patients. and weight loss. The gold standard for diagnosing and quantifying acid reflux is the 24-hour pH test. May be physiological. especially cold liquids. Clinical features: heartburn and regurgitation.
behind the pericardium. Local compression from tumor symptom Techniques for diagnosis: Radiography Chest CT scanning with intravenous contrast MRI Biopsy techniques :CT-guided core needle biopsy . Symptoms include: Chest pain，chills，Cough，Coughing up blood，Fever，Hoarseness，Night sweats，Shortness of breath，etc. Middle mediastinum. parathyroid lesions. gastroenteric cysts Symptoms: 50% of mediastinal tumors cause no symptoms Due to pressure on local structures. lymphoma Posterior mediastinum: neurogenic tumors. germ cell neoplasms. below the upper level of the pericardium. lymphoproliferative lesions. Mediastinal tumors in certain portions of the mediastinum: Superior mediastinum: thymomas. lymphangioma. thoracic duct. and lymph nodes. cardiac nerve. from sternum to spine. bronchogenic cyst. lipoma Middle mediastinum: pericardial cyst. thymic cyst. Endobronchial ultrasound (EBUS) -guided biopsy . . Categories: Divided into two parts by the plane from the sternal angle to the disc of T4-T5 An upper portion. VATS(video assisted thoracic surgery) . is named superior mediastinum A lower portion. aorticopulmonary-type paragangliomas. in front of the pericardium. thymus. thoracic inlet to diaphragm. is subdivided into three parts: Anterior mediastinum.Lecture 42 : Primary Tumors of Mediastinum Mediastinum -a thoracic cavity between pleural cavities.the heart. retrosternal thyroid glandular proliferations. hemangioma. Posterior mediastinum. trachea. the great vessels of the heart.Epithelial tumor generally considered to have an indolent growth pattern but malignant . containing the pericardium and its contents. parathyroid adenoma Anterior mediastinum: thymic epithelial tumors and cysts. esophagus. thyroid lesions. phrenic nerve. lymphoma. above the upper level of the pericardium.
-common autoimmune diseases associated with thymoma. Fat-fluid level may be seen on CT. Both adjuvant radiation therapy and chemotherapy were administered to stage IV and type C one month after operation. particularly if it is symptomatic. such as myasthenia gravis Thymomas are diagnosed with CT or MRI revealing mass in anterior mediastinum. clearly inoperable disease can be palliated(relieve the symptoms) for prolonged intervals with chemotherapy and/or radiation therapy only. Immature teratomas =malignant Diagnosis: serum tumor markers AFP and human beta-choriogonadotropin HCG CT shows fatty mass with globular calcifications and rarely a tooth or bone in the anterior mediastinum. has been the mainstay of therapy for early stage thymoma with excellent survival anticipated. mediastinoscopy and the transsternal approach. -common autoimmune diseases associated with thymoma. is a clear indication for surgery A large substernal goiters & compression on trachea dyspnea Bronchogenic cysts: . Treatment: conservative surgical removal. Strategy of treatment: type A and stage I thymoma had no adjuvant therapy after thymectomy Types AB and B1 thymomas had radiotherapy postoperatively. Types of surgery include thoracoscopy. Substernal goiters: -PredominanT in women. such as myasthenia gravis Diagnosis of Thynoma: Most common mediastinal neoplasm Epithelial tumor generally considered to have an indolent growth pattern but malignant between the ages of 40-60. Most diagnosis by accidental detection on chest radiograph Presence of a substernal goiter. stage II.between the ages of 40-60 years at the time of diagnosis with an equal gender distribution. Treatment of Thynoma: Surgical therapy+radiation therapy. because of the close proximity to important anatomic structures of the big vessels and heart. III were treated with adjuvant mediastinal radiation therapy. Teratomas: mediastinal germ cell tumors 20-40 years of age 90% occurring in men Mature teratomas =benign .
most common type of posterior mediastinal tumors 70.80% are benign and approximately 50% of patients are asymptomatic. then Pneumothorax. and their walls often contain cartilage and bronchial mucous glands. tend to be malignant and metastasize before symptoms appear. Adult neurogenic tumors are usually benign. definitive diagnosis is established only by surgical excision and tissue biopsy Complete extirpation(to remove by surgery) is necessary. Apart from Lymphomas treated with chemotherapy followed by radiation. main bronchi. . Most common mediastinal cysts 85%of bronchogenic cysts arise in the mediastinum in close relationship to the trachea. Most of the complications result from compression of adjacent structures. Diagnosis and treatment: Chest radiographs and CT scans are the most valuable diagnostic studies. carina lined by columnar ciliated epithelium. Infection is a common complication . Neurogenic Tumors: found in the posterior mediastinum are treated surgically with thoracotomy or thoracoscopy. Treatment: complete resection via thoracoscopic surgery or thoracotomy Lymphomas are recommended to be treated with chemotherapy followed by radiation. In children. other mediastinal tumors require surgery.
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