Mediastinal metastases from non-lymphomatous extra-thoracic tumours. A multicenter series of a rare condition (original) (raw)

Bulky Anterior Mediastinal Tumours: An Initial Experience in a Thoracic Oncology Unit

2020

Anterior mediastinum is the seat of majority of neoplastic growths arising from the thymus, fat, nerves, lymph nodes, and rarely thyroid and parathyroid. They usually remain clinically silent until late when they become huge and cause compressive symptoms or present after they complicate. Intra-thoracic fibromas are mesenchymal neoplasms that are exceedingly uncommon. There has been a persistent confusion regarding the nomenclature of this tumour which has included pleural fibroma, benign mesothelioma, submesothelial fibroma. benign mediastinal masses can be treated very effectively by various surgical approaches including VATS, thoracotomy or median sternotomy depending upon their location, size and surgical expertise. Postoperative outcome is usually fair as seen in our cases and recurrence is hardly evident. Malignant entities require a more sophisticated approach based on histopathology, ease of resectability and patient’s factor

Primary tumors of the mediastinum

Journal of Surgical Oncology, 1999

Background and Objectives: Diagnostic and therapeutic approaches to mediastinal tumors have changed over the past three decades. We reviewed our recent experience with these tumors and assessed the role of a multidisciplinary treatment approach. Methods: A retrospective review of 124 patients with primary mediastinal tumors over a 25-year period. Results: Median age was 35 years. Symptoms were present in 86 of 124 (69%) patients. One hundred and eleven of 124 (90%) tumors were malignant. Distant metastases were present at diagnosis in 14 of 124 (11%) patients. The most common tumor was thymoma (38/124, 31%), followed by germ-cell tumor (29/124, 23%), lymphoma (24/124, 19%), and neurogenic tumors (15/124, 12%). Seventy-four of 124 (60%) patients underwent resection, 88 (71%) received chemotherapy, and 97 (78%) received radiation therapy. Tumor recurrence occurred in 52% (47/91) of patients who initially had a complete resection or response to treatment. Median time to recurrence was 10 months. Overall median survival was 44 months. Metastatic disease at presentation (P ‫ס‬ 0.02) and tumor recurrence (P ‫ס‬ 0.00001) were the only significant independent predictors of survival on multivariate analysis. Conclusions: Malignant primary mediastinal tumors often require multimodality treatment. Despite improvements in survival with multimodality treatment, death from recurrent disease remains a problem.

Characteristics associated with complete surgical resection of primary malignant mediastinal tumors

Jornal Brasileiro de Pneumologia, 2009

OBJECTIVE: To identify preoperative characteristics associated with complete surgical resection of primary malignant mediastinal tumors. METHODS: Between 1996 and 2006, 42 patients with primary malignant mediastinal tumors were submitted to surgery with curative intent at a single facility. Patient charts were reviewed in order to collect data related to demographics, clinical manifestation, characteristics of mediastinal tumors and imaging aspects of invasiveness. RESULTS: The surgical resection was considered complete in 69.1% of the patients. Cases of incomplete resection were attributed to invasion of the following structures: large blood vessels (4 cases); the superior vena cava (3 cases); the heart (2 cases); the lung and chest wall (3cases); and the trachea (1 case). Overall survival was significantly better among the patients submitted to complete surgical resection than among those submitted to incomplete resection. The frequency of incomplete resection was significantly hi...

Mediastinal metastasis of primary extraneural ependymoma: Case report

Vojnosanitetski pregled, 2018

Introduction. The rarity of primary extraneural ependymomas (EnEs), its great variations in morphology and rare occurrence of metastasis, increase chances of misdiagnosis, particularly if they are found in paraovarian localization. Case report. The presented patient was diagnosed with malignant mesothelioma 14 years ago, after right salpingo-oophorectomy. In following years patient had multiple and extensive surgical procedures, resulting in different histopathological diagnoses, and after seven years, a diagnosis of EnE was established. Later on, patient was surgically treated in several medical centers across the region, again with different histopathological diagnoses. At present, the tumor metastasized to mediastinum, presenting as a grey to brown, multicystic formation with cysts filled with a clear serous fluid or red-brown hemorrhagic fluid. The inner surface of the cysts had smooth to partly papillary appearance. Tumor cells exhibited several architectural patterns (solid, p...

Unusual Anterior Mediastinal Tumors Treated at a Tertiary Thoracic Center: A Case Series Analysis

Cureus, 2021

Several tumors arise from different structures within the mediastinum. Although each type of mediastinal tumor has a predilection for a specific compartment, the progression of growth from one compartment to another can occur. The anterior mediastinum is the site of several tumors that pose interesting diagnostic and therapeutic challenges to thoracic surgeons. The anterior mediastinum is the seat of the majority of neoplastic growths within the mediastinum. Thymomas and lymphomas are the most common pathologies of the anterior mediastinum. Tumors of mesenchymal origin (hemangioma, lymphangioma, lipomas) and their malignant counterparts may occur in any of the mediastinal compartments. Less common tumors of the anterior mediastinal compartment are ectopic thyroid and parathyroid tumors, germ cell tumors, mesenchymal origin tumors, hemangiomas, and cervicomediastinal hygromas. Most of the mediastinal growths usually remain clinically silent until they become large and cause compressive symptoms. Here, we present a case series of five anterior mediastinal tumors consisting of solitary benign teratoma, fibrous benign tumor, malignant fibrosarcoma, hamartomatous chondroma, and malignant thymoma.

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...

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...

Surgery for invasive primary mediastinal tumors

The Annals of Thoracic Surgery, 1998

Background. There have been few reports on results after extended radical resection for primary mediastinal tumors invading neighboring organs. Methods. A retrospective analysis of 89 patients who underwent total or subtotal resection of a primary mediastinal tumor with resection of at least part of an adjacent structure between 1979 and 1995 was performed. Clinical data were collected from the medical records. Results. There were 35 invasive thymomas, 12 thymic carcinomas, 17 germ cell tumors, 16 lymphomas, 3 neurogenic tumors, 3 thyroid carcinomas, 2 radiationinduced sarcomas, and 1 mediastinal mesothelioma. The tumor was located in the anterior mediastinum in 74% of patients. Residual masses after chemotherapy were excised in 14 patients with germ cell tumor and 8 with lymphoma. A median sternotomy was the most frequently used approach (79% of patients). Total resection was achieved in 79% and significantly improved survival (p < 0.01). Adjacent resected structures included 38 phrenic nerves, 21 superior venae cavae, 16 upper lobes, and 13 innominate veins, in 5 patients, a pneumonectomy was required. The complication rate was 17% and the mortality rate, 6%. With follow-up available for 86 patients, the overall 5-year survival rate was 69% for patients with thymoma, 42% for patients with thymic carcinoma, 48% for patients with germ cell tumor, and 83% for patients with lymphoma. Conclusions. Malignant mediastinal tumors can be safely resected even if they have invaded other mediastinal structures. Complete resection is important to achieve satisfactory long-term survival. A median sternotomy is an excellent approach, and a preoperative diagnosis by biopsy is desirable. Residual masses after chemotherapy for lymphoma or germ cell tumor should be resected. Extensive resection without a preoperative diagnosis is not indicated.

Diagnosis and Treatment of Mediastinal Tumors by Thoracoscopy

Objectives: Thoracoscopic management of mediastinal tumors is still subject to analysis. Seventythree patients underwent thoracoscopy for treatment of mediastinal masses and were analyzed retrospectively in order to evaluate the effectiveness and complications of the procedure. Methods: Between 1983 and 1999, 21 conventional thoracoscopies and 52 video-assisted thoracic surgeries were performed (33 for diagnostic purposes and 40 for therapy). Patient ages ranged from 2 to 81 years (mean, 43.8 years) with a slight predominance of girls and women over men and boys (41 vs 32, respectively). All patients underwent general anesthesia using simple intubation (22 patients) or double-lumen intubation (51 patients). Results: The histologic type of tumors was obtained in all patients. For therapeutic purposes, a change of procedure to thoracotomy was necessary in nine patients. The reasons for this change were tumor size, tumor invasion of nearby structures, difficulties in continuing the dissection, the performance of an upper lobectomy, and suturing the iatrogenic lesion of the diaphragm. Four patients died during the first 30 postoperative days as a consequence of their primary pathology. Conclusion: Thoracoscopy was confirmed as an effective diagnostic and therapeutic alternative for the treatment of mediastinal disorders.