Mediastinal Tumors

Chairperson: dr Prashant Hombal

Co chairperson: dr m I uppin

Presenter: Dr Ameya
Mediastinal tumors

As discussed earlier the mediastinum refers

to the central area in the chest between the
thoracic inlet and the diaphragm, between
the right and left pleural surfaces, and
which extends from the inner aspect of the
sternum to the vertebral column

The image describes the arbitrary

compartments of mediastinum and
important masses within each compartment
Primary mediastinal cysts

Primary cysts of the mediastinum account for approximately 20% of mediastinal masses

Cysts are characterized from the organ of origin and may be bronchogenic, pericardial, enteric, or thymic or
may be of an unspecified nature
 Bronchogenic cysts:

Account for most primary cysts of the

mediastinum.

Originate as sequestrations from the ventral

foregut and can be situated within the lung
parenchyma or the mediastinum.

Two thirds of bronchogenic cysts are

asymptomatic.

In infants, cysts cause severe respiratory

compromise by compressing the trachea or the
bronchus.
 Pericardial cysts:

Occur in the cardiophrenic angle mostly on the right

side.

These cysts may or may not communicate with the

pericardium.

The characteristics of pericardial cysts include

location in the cardiophrenic angle, characteristic
appearance, smooth borders, and attenuation
approximating water for the cyst fluid.
 Enteric cysts:

Also known as duplication cysts arise from the

primitive foregut, which develops into the upper
division of the gastrointestinal tract.

These cysts are usually attached to the esophagus.

Symptoms occur as size increases with compression

of the esophagus and dysphagia.

Neuroenteric cysts are associated with anomalies of

the vertebral column.
Thymoma

Thymoma is the most common neoplasm of

the anterosuperior compartment.

The peak incidence is in the third through

fifth decades

Thymomas vary in behaviour from benign

to aggressively invasive
Thymic carcinoma

Suster and Rosai classified it as low grade

and high grade

Must differentiate from lung cancer

metastasis to thymic gland
Germ Cell Tumors

Germ cell tumors arise from primordial germ cells that fail to complete the
migration from the urogenital ridge and rest in the mediastinum.
The anterosuperior mediastinum is the most common extragonadal primary site
of these tumors.
 Teratomas:
• Most common mediastinal germ cell
neoplasms and are located most
commonly in the anterosuperior
mediastinum.
• Malignant tumors are differentiated
from benign tumors by the presence of
primitive (embryonic) tissue or by the
presence of malignant components.
Malignant Nonteratomatous Germ
cell Tumor
Malignant germ cell tumors occur
predominantly in the anterosuperior
mediastinum
• Seminomas:
Seminomas constitute 50% of malignant germ
cell tumors.

Seminomas usually remain intrathoracic.

Symptoms are related to the mechanical effects

of the tumor on adjacent mediastinal and
pulmonary structures.
• Nonseminomatous tumors:

Malignant nonseminomatous germ cell tumors

include choriocarcinomas, embryonal cell
carcinomas, immature teratomas, teratomas with
malignant components, and endodermal cell
(yolk sac) tumors

Occur mostly in men in their third or fourth

decades.
Neurogenic Tumors

Neurogenic tumors are usually located in the posterior mediastinum

Originate from the sympathetic, the intercostal nerves and the paraganglia
cells.
Tumors of nerve sheath origin predominate in adults. Most present as
asymptomatic incidental findings, and most are benign.

In children and young adults, tumors of the autonomic ganglia predominate,

with up to two thirds being malignant.
 Neurilemoma or schwannoma:
• Originates from perineural Schwann cells.
• They are benign, slow-growing neoplasms that
frequently arise from a spinal nerve root but can
involve any thoracic nerve.
• These tumors are well circumscribed and have a
defined capsule. They arise from the nerve sheath
and extrinsically compress the nerve fibers.
• The peak incidence of these tumors is in the third
through fifth decades of life
 Neuroblastoma:
• Neuroblastomas originate from the sympathetic
nervous system.

• Highly malignant, neuroblastomas are the most

common extracranial solid malignancy of childhood.

• The primary site is intrathoracic malignancy in 14%

• These are highly invasive neoplasms that have

frequently metastasized before diagnosis.
Lymphoma
Lymphoma is a common cause of a mediastinal
mass lesion, particularly in the anterior
mediastinum

Patients usually have symptoms; chest pain,

cough, dyspnea, hoarseness, and superior vena
cava syndrome are the most common clinical
manifestations.

Nonspecific systemic symptoms of fever and

chills, weight loss, and anorexia are frequently
noted and are important in the staging of
patients with Hodgkin lymphoma.
Clinical Features
Pulmonary symptoms
Pulmonary symptoms result from the direct effect of the tumor on the bronchus or lung tissue.

Cough (secondary to irritation or compression of a bronchus)

Dyspnea (usually due to central airway obstruction or compression, with or without atelectasis)
Wheezing (with narrowing of a central airway of >50%)

Hemoptysis (typically, blood streaking of mucus that is rarely massive; indicates a central airway
location)

Pneumonia (usually due to airway obstruction by the tumor)

Lung abscess (due to necrosis and cavitation, with subsequent infection).

Nonpulmonary Thoracic Symptoms

Nonpulmonary thoracic symptoms result from invasion of the primary tumor

directly into a contiguous structure or from mechanical compression of a
structure
Pancoast’s syndrome: Tumors originating
in the superior sulcus (posterior apex) elicit:
apical chest wall and/or shoulder pain (from
involvement of the first rib and chest wall)
Horner’s syndrome: unilateral
enophthalmos, ptosis, miosis, and facial
anhidrosis from invasion of the stellate
sympathetic ganglion

Superior Vena Cava Syndrome: SVC

syndrome symptoms include variable
degrees of swelling of the head, neck, and
arms; headache; and conjunctival edema
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Recurrent laryngeal nerve (RLN): Involvement most commonly occurs on the
left side, given the hilar location of the left RLN as it passes under the aortic
arch. Symptoms include voice change, often referred to as hoarseness, but more
typically a loss of tone associated with a breathy quality, and coughing,
particularly when drinking liquids

Haemorrhage, due to erosion of major vessels by malignant tumour.

Back pain: Results from direct invasion of a vertebral body and is often
localized and severe. If the neural foramina are involved, radicular pain may also
be present.

Dysphagia: is usually secondary to external esophageal compression

Pleural effusion
Thank you