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'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''


{{SI}}
{{Mediastinal tumor}}
{{CMG}}
{{CMG}}


==Overview==
==[[Mediastinal tumor overview|Overview]]==


Masses in the anterior portion of the [[mediastinum]] can include [[thymoma]], [[lymphoma]], and [[germ cell tumor]]s including [[teratoma]].  [[Lung cancer]] typically spreads to the [[lymph node]]s in the [[mediastinum]].
==[[Mediastinal tumor classification|Classification]]==


Anterior [[mediastinum|mediastinal]] compartment, also known as anterosuperior compartment, is anterior to the [[pericardium]]. Masses in this area is more likely to be malignant than those in other compartments Most common masses found here include [[thymoma]]s, [[germ cell tumor]]s, [[lymphoma]]s, [[thyroid]] tissue, and [[parathyroid]] lesions.
==[[Mediastinal tumor historical perspective|Historical Perspective]]==


==Thymoma==
==[[Mediastinal tumor pathophysiology|Pathophysiology]]==
'''{{main|thymoma}}'''


Most common primary anterior mediastinal tumor (20%) in adults but rarely seen in children. It can be classified as lymphocytic, epithelial, or spindle cell histologies, but this is not very significant clinically. Tonofibrils seen under [[electron microscopy]] can differentiate [[thymoma]] from other tumors such as [[carcinoid]], Hodgkin's, and [[seminoma]]. Patients are usually asymptomatic but can present with [[myasthenia gravis]]-related symptoms, [[substernal pain]], [[dyspnea]], or [[cough]]. Invasive tumors can produce compression effects such as [[superior vena cava syndrome]].
==[[Mediastinal tumor epidemiology and demographics|Epidemiology & Demographics]]==


[[Thymoma]]s are diagnosed with [[CT]] or [[MRI]] revealing mass in anterior [[mediastinum]].
==[[Mediastinal tumor epidemiology and demographics|Risk Factors]]==


Therapy in stage I tumors consists of surgical resection with good prognosis.
==[[Mediastinal tumor screening|Screening]]==


Stage II-III requires maximal resection possible followed by radiation.
==[[Mediastinal tumor causes|Causes]]==


Stage IV disease requires addition of cisplatin-based chemotherapy in addition to those in stage II and III.
==[[Mediastinal tumor differential diagnosis|Differentiating Mediastinal tumor from other Diseases]]==


For those with invasive thymoma, treatment is based on induction chemotherapy, surgical resection, and post-surgical radiation.
==[[Mediastinal tumor natural history|Natural History, Complications & Prognosis]]==


5-year survival for invasive thymoma is between 12-54% regardless of any [[myasthenia gravis]] symptoms.
==Diagnosis==
[[Mediastinal tumor history and symptoms|History & Symptoms]] | [[Mediastinal tumor physical examination|Physical Examination]] | [[Mediastinal tumor staging|Staging]] | [[Mediastinal tumor laboratory tests|Lab Tests]] | [[Mediastinal tumor electrocardiogram|Electrocardiogram]] | [[Mediastinal tumor chest x ray|Chest X Ray]] | [[Mediastinal tumor CT|CT]] | [[Mediastinal tumor MRI|MRI]] | [[Mediastinal tumor echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Mediastinal tumor other imaging findings|Other Imaging Findings]] | [[Mediastinal tumor other diagnostic studies|Other Diagnostic Studies]]


==Lymphoma==
==Treatment==
'''{{main|lymphoma}}'''
[[Mediastinal tumor medical therapy|Medical Therapy]] | [[Mediastinal tumor surgery|Surgery]] | [[Mediastinal tumor primary prevention|Primary Prevention]] | [[Mediastinal tumor secondary prevention|Secondary Prevention]]  
 
Secondary most common primary anterior mediastinal mass in adults. Most are seen in the anterior compartment and rest are seen in middle compartment. Hodgkin's usually present in 40-50's with nodular sclerosing type, and non-Hogdkin's in all age groups. Can also be primary mediastinal B cell lymphoma with exceptionally good prognosis <ref>J Exp Med. 2003 Sep 15;198(6):851-62</ref> <ref>Leukemia and Lymphoma, Volume 49, Issue 6 June 2008 , pages 1050 - 1061.</ref> <ref>The Oncologist, Vol. 11, No. 5, 488-495, May 2006; doi:10.1634/theoncologist.11-5-488</ref>
 
Common symptoms include [[fever]], [[weight loss]], [[night sweat]]s, and compressive symptoms such as [[pain]], [[dyspnea]], [[wheezing]], [[SVC syndrome]], [[pleural effusion]]s.
 
Diagnosis usually by [[CT]] showing lobulated mass. Confirmation done by tissue [[biopsy]] of accompanying nodes if any, [[mediastinoscopy]], mediastinotomy, or [[thoracotomy]]. FNA biopsy usually not adequate.
 
Treatment of mediastinal Hodgkin's involves chemotherapy and/or radiation. 5 year survival is now around 75%. Large-cell type may have somewhat better prognosis. Surgery is generally not performed because of invasive nature of tumor.
 
Of all [[lymphoproliferative disorders|cancers involving the same class of blood cell]], 2% of cases are mediastinal large B cell lymphomas.<ref name="isbn0-7817-5007-5">{{cite book
|author=Turgeon, Mary Louise
|title=Clinical hematology: theory and procedures
|publisher=Lippincott Williams & Wilkins
|location=Hagerstown, MD
|year=2005
|pages=283
|isbn=0-7817-5007-5
|quote=Frequency of lymphoid neoplasms. (Source:  Modified from WHO Blue Book on Tumour of Hematopoietic and Lymphoid Tissues. 2001, p. 2001.)
}}</ref>
 
==References==
{{Reflist|2}}


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{{Tumors}}
{{SIB}}


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Revision as of 20:39, 22 January 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

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Historical Perspective

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Causes

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Natural History, Complications & Prognosis

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