Mediastinal Masses: Pathophysiological Issues and Management Challenges in a Developing World (original) (raw)
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Presentation of primary mediastinal masses in Ibadan
East African Medical Journal, 2004
Objective: To determine clinical features, anatomic location and histological types of primary mediastinal masses diagnosed and treated in a black African population. Design: A retrospective study of clinical data collected from patients case notes, the cardiothoracic unit's and pathology records between June 1975 and May 1999. Setting: University College Hospital, Ibadan, Nigeria which hosts a major cancer center in the West African sub-region, and serves community clinics. Patients: All patients with primary mediastinal masses referred for evaluation and treatment. Main outcome measures: Excluded metastatic, oesophageal and vascular-lesions. All patients had radiological evalulation and tissue biopsies. The anatomic subdivision of the mediastinum into anterosuperior, middle and posterior section was used. Results: One hundred and five consecutive patients were evaluated and treated. The mean age was 34.0 ± 20.4 years. There were 75 males and 30 females. Eighty one (77.1%) were symptomatic, 24 (22.9%) were asymptomatic. Thirty seven (45.7%) of the symptomatic patients had malignant disease while 44 (54.3%) had benign disease. Forty five patients (43%) and 60 patients (57%) had malignant and benign diseases respectively. Incidence of symptoms, was 82.2% for malignant and 73.3% for benign diseases. This difference in incidences is statistically insignificant (p=0.283). Majority of asymptomatic patients (70.8%) had benign disease while 29.2% of patients with malignancy were asymptomatic. This difference in incidence was statistically significant (p=0.0039). The frequency of mediastinal masses were anterosuperior, in 67 patients (63.8%), posterior mediastinal, 24 patients (22.9%) and middle mediastinal in 14 patients (13.3%). Lymphoma 23 (21.9%), thymus glands tumours 19 (18.1%) and endocrine tumours (goiters) 18 (17.1%) were the commonest types of primary mediastinal masses treated. Conclusion: Majority of our patients with mediastinal masses (whether benign or malignant) are symptomatic and the absence of symptoms is more associated with benign disease. Majority of lesions are situated in the anterosuperior mediastinum. Lymphoma is the most frequent primary mediastinal mass.
Spectrum of malignant mediastinal masses at a tertiary care centre in Central India
International Journal of Research in Medical Sciences, 2018
Background: Malignant mediastinal masses can develop from structures that are normally located or pass through the mediastinum during development, as well as from metastases of malignancies that arise elsewhere in the body. Since many tumors that occur in the mediastinum are undifferentiated and have overlapping histologic features, one must consider a broad differential diagnosis and perform a thorough evaluation. This is particularly important since appropriate therapy for various mediastinal tumors differs considerably and may significantly impact survival.Methods: Ours was a retrospective descriptive study of 48 patients who presented or referred to medical oncology department from January 2014 to December 2017 and in whom malignant cause of mediastenal mass was established. All details of the patients pertinent epidemiology, clinical history and pathological including immunohistochemistry details were studied.Results: Out of 48 patients,14 cases (29.2%) were in adolescent and y...
Evaluation of 95 Cases with Mediastinal Tumors
journal of cardio-thoracic medicine, 2015
Introduction:Mediastinum contains different vital structures that are located in the anterior and middle or posterior compartments. Various types of mediastinal masses or tumors can be seen in the mediastinum. Materials and Methods:This case series study was performed on 95 patients who had referred to Mashhad University of Medical Sciences between 1990 and 2010 were reviewed. The Inclusion criteria were as follows: Having primary mediastinal masses; Exact tissue pathology; Having received suitable treatment as well as having completed a 3-year follow-up after surgery; The major variables were age, sex, clinical symptoms, mass location, diagnostic procedures, imaging studies, tissue pathology, postoperative complications, mortality and a long-term survival. The patients were followed up for 3 years after the surgery. Results:Ninety-five patients enrolled in the study with M/F=51/44 and the mean age of 35.4+16.52 years. Moreover, anterior mediastinum was the compartment mostly involv...
Journal of Evidence Based Medicine and Healthcare
BACKGROUND Mediastinal masses, an enigma to surgical pathologist are among the most complicated lesions explored and relatively inaccessible. They often connote a process with mass effect presenting with superior mediastinal syndrome. This is a challenging area faced by surgical pathologist as varied lesions are found here and often biopsies obtained are tiny and crushed. Appropriate therapy of various mediastinal tumours differs considerably and may significantly impact survival. We wanted to evaluate the various lesions in different compartments of mediastinum and categorise them according to anatomical location, and histopathology. METHODS Patients with mediastinal masses attending outpatient department were selected, history taken and relevant investigations done with radiological evaluation for proper anatomical location of lesion. Histopathological study done on tissues obtained by ultrasound / CT guided biopsy, open surgical biopsy were categorized according to histologic typ...
A diagnostic approach to the mediastinal masses
Insights into Imaging, 2012
Background Multiple different types of mediastinal masses may be encountered on imaging techniques in symptomatic or asymptomatic patients. The location and composition of these lesions are critical to narrowing the differential diagnosis. Methods Radiological compartmentalisation of the mediastinum helps in focusing the diagnosis of masses on the basis of their site. Some diseases, however, do not occur exclusively in any specific compartment and can spread from one compartment to another. Results Tissular components of the mass, the degree of vascularisation and the relationships with mediastinal structures assessed by computed tomography (CT) or magnetic resonance imaging (MRI) are a leading edge of the radiological diagnosis. Special applications at MRI have been developed over the recent years in order to identify accurately tissular components of the mediastinal masses. The likelihood of malignancy of the mediastinal masses is influenced by the symptomatology and the age of the patient. This article reviews the most commonly encountered mediastinal masses considering clinical history and manifestations, anatomical position and certain details seen on different imaging modalities that allow correct diagnosis in many cases. Conclusion Familiarity with the radiological features of mediastinal masses facilitates accurate diagnosis, differentiation from other mediastinic processes and, thus, optimal patient treatment. Teaching Points • CT and MRI are important for the diagnosis of mediastinal masses. • The location and tissue characteristics on imaging studies are critical to narrow down the differential diagnosis of mediastinal masses. • Symptomatology and patient age affect the likelihood of malignancy.
Epidemiology of Mediastinal Tumors during Six Years (2006-2012) in Rasht City
Mediastinal masses are relatively uncommon and continue to be an interesting diagnostic and therapeutic challenge to thoracic surgeons. Although they tend to be more common in young and middle-aged adults, numerous types of mediastinal tumors and cysts affect people of all age groups. Epidemiologic survey of mediastinal tumors can get important information for physician and health experts. In this retrospective descriptive cross sectional study, documents of 109 patients with primary diagnosis of mediastinal tumor managed in the Razi hospital between march 2006 and march 2012 were reviewed. 8 cases were excluded. Statistical analysis was done with SPSS (version 16). This study was carried out on 101 patients, the mean age was 35.84±1.71 years and 56.4% of them were male. The most common mediastinal tumors were Non-Hodgkin lymphoma (30.7%), Thymoma (13.8%) and Hodgkin lymphoma (12.9%) respectively. 78.2% of tumors was in the anterior mediastinum. the most common symptoms were Cough a...
Mediastinal masses - the bad, the ugly and the unusual!
2007
Background: Differential diagnosis of mediastinal masses is wide and management of individual cases can be challenging. In addition to common malignancies e.g. lymphomas and thymomas. Many other benign and malignant conditions can present with mediastinal masses. Patients and Methods: We describe five patients with a diagnosis of mediastinal mass. We wish to showcase the range of diagnosis possible in these situations. This is followed by a brief discussion on the general approach to such cases. Conclusion: A good history, detailed careful clinical examination, judicious use of imaging and investigations e.g. blood counts and tumour makers can give a vital clue to the diagnosis of mediastinal mass.
Diagnostic approach to mediastinal masses
European Journal of Radiology, 1998
Mediastinal masses represent a vast group of tumours and pseudo-tumours which can involve the various compartments of the mediastinum. The authors propose a radiologic diagnostic approach starting from the plain thoracic radiograph with study of the mediastinal lines and oesophageal transit and going on to the classifications made possible by modern CT and MR imaging. The proposed diagnostic procedure is based on nine mediastinal lines and two 'threads of Ariadne' which are the compartments where the masses are located and their behaviour at CT (densitometry before and after administration of an iodinated bolus) and at MRI (T 1 , T 2 , gadolinium-enhanced T 1-weighted sequences). The definitive aetiological diagnosis may be established by surgery, but also in certain cases by percutaneous needle biopsy.