Primary Mediastinal Tumors: Part ll. Tumors of the Middle and Posterior Mediastinum

doi:10.1378/chest.112.5.1344

Chest

Volume 112, Issue 5, November 1997, Pages 1344-1357

https://doi.org/10.1378/chest.112.5.1344 Get rights and content

Lymphoma, mediastinal cysts, and neurogenic neoplasms are the most common primary middle and posterior mediastinal tumors. Lymphoma may involve the anterior, middle and/or posterior mediastinum, frequently as lymphadenopathy or as a discrete mass. Foregut cysts are common congenital mediastinal cysts and frequently arise in the middle mediastinum. Pericardial cysts are rare. Schwannoma and neurofibroma are benign peripheral nerve neoplasms, represent the most common mediastinal neurogenic tumors, and rarely degenerate into malignant tumors of nerve sheath origin. Sympathetic ganglia tumors include benign ganglioneuroma and malignant ganglioneuroblastoma and neuroblastoma. Lateral thoracic meningocele is a rare cause of a posterior mediastinal mass.

Section snippets

PRIMARY MEDIASTINAL LYMPHOMAS

Lymphoma is one of the most common mediastinal tumors¹,² and may manifest as a primary mediastinal lesion, or more frequently, as generalized disease.3, 4, 5 Hodgkins disease (HD) and non-Hodgkin's lymphoma (NHL) are unique and separate entities⁶ that may have overlapping features. Both may affect the mediastinum, although it is infrequent for either to be limited to the mediastinum at the time of diagnosis.³,⁴,⁷ HD represents only 25 to 30%;⁸ of all cases of lymphoma. However, 50 to 70%;⁷ of

Foregut Cysts

Congenital foregut cysts are the most common mediastinal cysts, accounting for approximately 20%; of mediastinal masses.³¹,³² Bronchogenic cysts represent 50 to 60%; of all mediastinal cysts while enterogenous cysts, which include esophageal duplication and neurenteric cysts, constitute 5 to 10%; and 2 to 5%;, respectively. Up to 20%; of mediastinal foregut cysts lack specific histologic features to permit further classification, possibly because of prior hemorrhage or infection, and are termed

NEUROGENIC TUMORS

Neurogenic tumors represent approximately 20%; of all adult and 35%; of all pediatric mediastinal neoplasms.¹,²,⁵⁹,⁶⁰ Neurogenic tumors are the most common cause of a posterior mediastinal mass. Approximately 90%; occur in the posterior mediastinum,⁵⁹ and they comprise 75%; of primary posterior mediastinal neoplasms.⁶¹ Seventy to 80%; are benign and approximately half of the patients are asymptomatic.² Neurogenic tumors are generally grouped into three categories: those arising from peripheral

CONCLUSION

Middle and posterior mediastinal masses include lesions of many etiologies. Lymphoma is a lymphoproliferative malignancy that may affect any mediastinal compartment and that classically manifests as nodal enlargement. The diagnosis is frequently made by biopsy of a palpable peripheral node, and mediastinal involvement is determined by cross-sectional imaging studies. Diagnostic problems may arise when lymphoma manifests with primary mediastinal lymphadenopathy or focal mass. Mediastinal cysts

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Three-port video-assisted thoracic surgery of a vagal schwannoma with bronchial stenosis: A case report
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Diagnostic approach for mediastinal masses with radiopathological correlation
2023, European Journal of Radiology
Mediastinal masses have various histopathological and radiological findings. Although lymphoma is the most common type of tumor, thymic epithelial and neurogenic tumors are common in adults and children, respectively, but several other types are difficult to distinguish. No previous review has simply and clearly shown how to differentiate mediastinal masses.
We conducted a review of the latest mediastinal classifications and mass differentiation methods, with a focus on neoplastic lesions. Both older and recent studies were searched, and imaging and histopathological findings of mediastinal masses were reviewed. Original simple-to-use differentiation flowcharts are presented.
Assessing localizations and internal characteristics is very important for mediastinal mass differentiation. The mass location and affected organ/tissue should be accurately assessed first, followed by more qualitative diagnosis, and optimization of the treatment strategy. In 2014, the International Thymic Malignancy Interest Group presented a new mediastinal clinical classification. In this classification, mediastinal masses are categorized into three groups according to location: prevascular (anterior)-, visceral (middle)-, and paravertebral (posterior)-compartment masses. Then, the internal characteristics and functional images are evaluated.
Differentiation of mediastinal masses is very difficult. However, if typical imaging findings and clinical characteristics are combined, reasonable differentiation is possible. In each patient, proper differential diagnosis may contribute to better treatment selection.
A 60-Year-Old Woman With Posterior Mediastinal Tumor
2022, Chest
Transesophageal endoscopic resection of mediastinal cysts (with video)
2022, Gastrointestinal Endoscopy
Citation Excerpt :
Most are embryonic in origin.1 According to the tissue of origin, they can be classified into foregut cysts, thymic and parathyroid cysts, pleuropericardial cysts, mediastinal cysts with Müllerian differentiation (Hattori cysts), and acquired mediastinal cysts.1,5,7 Foregut cysts are derived from the embryonic foregut and include bronchogenic cysts and enteric cysts (ie, esophageal duplication cysts, gastroenteric cysts, and a special form of enteric cysts, the neurenteric cysts).1,7
Primary mediastinal cysts are infrequent lesions derived from a variety of mediastinal organs or structures. Complete surgical resection is the treatment of choice even in asymptomatic patients to prevent severe adverse events (AEs) and to establish the diagnosis. Transesophageal endoscopic resection of benign mediastinal tumors has been proven feasible. The aim of this study was to evaluate the feasibility, safety, and efficacy of transesophageal endoscopic surgery for mediastinal cysts.
From January 2016 to May 2021, patients with mediastinal cysts who underwent transesophageal endoscopic resection were retrospectively included. Clinicopathologic characteristics, procedure-related parameters, AEs, and follow-up outcomes were analyzed.
Ten patients with mediastinal cysts were included in this study. The mean cyst size was 3.3 ± 1.3 cm. Histopathology revealed 3 bronchogenic cysts (30.0%), 4 esophageal duplication cysts (40.0%), 2 gastroenteric cysts (20.0%), and 1 lymphatic cyst (10.0%). All procedures were performed uneventfully without conversion to traditional surgery. En-bloc resection was achieved in 6 patients (60.0%). Aggressive resection was avoided to prevent damage to the surrounding vital organs. Mean resection time and suture time were 58.0 ± 36.4 minutes and 5.4 ± 1.0 minutes, respectively. No major pneumothorax, bleeding, mucosal injury, or fistula occurred. One patient had a transient febrile episode (>38.5°C). Mean postoperative hospital stay was 2.7 ± .9 days. No residual or recurrent lesions were observed in any patient during a mean follow-up period of 29.8 ± 19.5 months.
Transesophageal endoscopic surgery appears to be a feasible, safe, effective, and much less invasive approach for mediastinal cyst resection. Larger prospective studies are required to fully assess the efficacy and safety of this novel technique.
A Rare Case of Giant Mediastinal Ganglioneuroma in A 3-year-old
2022, Radiology Case Reports
Ganglioneuroma is a rare, differentiated, and benign neurogenic tumor that could grow into a huge size with minimal or no symptoms at all. Ganglioneuroma is typically found in older children or adults and is commonly detected within the posterior mediastinum (other than retroperitoneal). Here, we present a case of a 3-year-old patient with shortness of breath, and radiological examination showed a giant mediastinal tumor which proved to be a ganglioneuroma after histopathological examination. This study highlights the possibility of ganglioneuroma occurring in younger children and the role of imaging in assessing ganglioneuroma as a posterior mediastinal tumor.
Should spring water cysts of the mediastinum require excisional resection? A case report
2021, International Journal of Surgery Case Reports
Mediastinal cysts account for 20–32% of all mediastinal lesions. Complete surgical excision is the standard therapy for mediastinal cysts. Translucent cysts containing crystal-clear fluid are called “spring water cysts.” We experienced a case of mediastinal spring water cyst fenestrated under video-assisted thoracoscopy with a miniaturized endoscope (mini-VATS) as an alternative to excisional resection.
A 49-year-old woman presented with back pain. Chest CT revealed a posterior mediastinal mass measuring 4.2 × 1.8 × 3.2 cm closed to the tenth thoracic vertebra. Chest MRI demonstrated hypo-intensity on T1-weighted images and hyper-intensity on T2-weighted images. It was estimated that the posterior mediastinal mass did not contain a tumor component. The tumor was growing and symptomatic; therefore, we performed surgical cyst fenestration without excision of the cyst under mini-VATS. The patient experienced complete relief of symptoms. Fluid accumulation in the cyst was not observed on CT images 12 months postoperatively.
Kozu et al. reported that all 108 primary mediastinal cysts were resected completely and were recurrence-free after a mean follow-up of 41 ± 26 months. In the case of a functional hydrocele such as spring water cyst, we believe that even if fluid is produced, the thoracic pleura is capable of absorbing the fluid, and the cyst wall might not recur even if the wall is left in place. Fluid drainage through fenestration may prevent recurrent fluid collection.
Fenestration of non-neoplastic mediastinal cysts under mini-VATS might be a less invasive radical procedure compared to complete resection.

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: The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as representing the views of the Department of the Air Force or the Department of Defense.

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Chest

ReviewsPrimary Mediastinal Tumors: Part ll. Tumors of the Middle and Posterior Mediastinum

Section snippets

PRIMARY MEDIASTINAL LYMPHOMAS

Foregut Cysts

NEUROGENIC TUMORS

CONCLUSION

Ann Thorac Surg

Am J Med

Blood

J Pediatr Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Pediatr Surg

Ann Thorac Surg

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

Chest

J Thorac Cardiovasc Surg

Radiol Clin North Am

Ann Thorac Surg

Surg Clin North Am

Ann Thorac Surg

Pediatr Surg

Surgical treatment of mediastinal tumors

J Thorac Cardiovasc Surg

Mediastinal lymphoma

Semin Diagn Pathol

Hodgkin's disease of the thymus gland

Cancer

Natural history of Hodgkin's disease as related to its pathologic picture

Cancer

New concepts in the non-Hodgkin lymphomas: radiologic implications

Radiology

Prognostic significance of mediastinal mass in adult Hodgkin's disease

Cancer

The non-Hodgkin's lymphomas: practical concepts for the diagnostic radiologist

Radiology

Radiographic distribution of intrathoracic disease in previously untreated patients with Hodgkin's disease and non-Hodgkin's lymphoma

Radiology

Primary mediastinal B-cell lymphoma with sclerosis: an aggressive tumor with distinctive clinical and pathologic features

J Clin Oncol

Lymphoma of the mediastinum and lung

Malignant lymphomas-a conceptual understanding of morphologic diversity

Am J Pathol

Correlation of histopathology with other prognostic indicators in Hodgkin's disease

Cancer

Tumors of the thymus

Concurrent development of a thymic cyst and mediastinal Hodgkin's disease

Med Pediatr Oncol

Cystic degeneration of thymic Hodgkin's disease following radiation therapy

Cancer

Hodgkin disease: clinical utility of CT in initial staging and treatment

Radiology

Hodgkin disease: contributions of chest CT in the initial staging evaluation

Radiology

The significance of residual mediastinal abnormality on the chest radiograph following treatment for Hodgkin's disease

J Clin Oncol

The significance of necrotic mediastinal lymph nodes on CT in patients with newly diagnosed Hodgkin disease

AJR Am J Roentgenol

The role of computed tomography in the initial staging and subsequent management of the lymphomas

J Comput Assist Tomogr

Lymphomas: MR imaging contrast characteristics with clinical-pathologic correlations

Radiology

Thymic hyperplasia masquerading as recurrent Hodgkin's disease: case report and review of the literature

J Surg Oncol

Hodgkin disease

Acute lymphoblastic leukemia and non-Hodgkin's lymphoma with mediastinal mass—a study of 23 children; different disorders or different stages?

Leuk Lymphoma

Role of chest CT in non-Hodgkin lymphoma

Radiology

Non-Hodgkin's lymphomas

Leukemias and lymphomas of childhood

Reviews
Primary Mediastinal Tumors: Part ll. Tumors of the Middle and Posterior Mediastinum