1. به نام خدا

2. Mediastinal Tumors and Cysts
دکتر یونس شفیق
متخصص جراحی عمومی
استادیار دانشگاه علوم پزشکی قزوین

3. Introduction Silent in early phase Mainly cause pressure symptoms
Incidentally discovered by routine x-rays
Specific disease entities according to anatomical, and embryologic origin
50% malignant in children where as 25% in adults
Metastatic tumor is the most common tumor

4. Symptoms and Signs Pain Cough Hemoptysis SVC syndrome Hoarseness
Dyspnea
Horner’s syndrome
Dysphagia
Pleural effusion
Stridor
Myathenia Gravis
Phrenic nerve palsy
Chylothorax

5. Diagnosis Chest PA & Lateral Bucky film Chest CT Fluoroscopy
Bronchoscopy
Esophagogram
NAB
Isotope Scanning
Angiography
Thoracotomy
VATS
Medistinoscopy

8. Common Diseases of the Mediastinum

10. Thymoma Anterior and Superior mediastinum
Most common (20%)of mediastinal tumor in adults but rarely seen in children
2/3 is malignant
Equal frequency in males and females
30 – 50 yrs
Various Classification : Lymphocytic, Epithelial, Spindle Cell
50% are asymptomatic
Associated diseases : MG (35%), PRCA, DiGeroge SD, Carcinoid, Eaton-Lambert, agammaglobulinemia, myocarditis, thyrotoxicosis, etc

11. Thymoma (Staging) Stage I : contained within an intact capsule
Stage II: extension through the capsule to surrounding fat, pleura, pericardium
Stage III : Intrathoracic metastasis
Stage IV: Extrathoracic Metastasis

12. Thymoma(Treatment) Stage I : Surgical resection Recurrence 2-12%
Stage II & III : Surgery + Radiotherapy
Stage IV : Multimodality Induction chemotherapy, surgery + post op Radiotherapy
5-year Survival 12 – 54 %, not affected by the presence of Myasthenia Gravis

13. Thymoma

14. Thymoma
Ca++
mass

17. Thymus

18. Lymphoma Metastatic is most common 5-10% is mediastinal primary
Second moost common Anterior Mediastinal Mass in Adults
Malignant > Hodgkin’s
Dx: Mediastinoscopy, thoracotomy
NAB : Usually not confirmatory

19. Hodgkin’s Lymphoma
“mediastinal widening”

21. Germ Cell Tumors Anterior Mediastinal location
Mainly in late teens 15 %of Ant. Med. Tumors in Adults, 24 % in children
1/5 is Malignant
Cystic Teratoma(Dermoid Cyst) vs. Solid tumor (Teratoma)
Solid tumor : 1/3 malignant
Radiosensitive
Teratoma, Malignant teratoma, Seminoma(dysgerminomas)

22. Teratoma

23. Teratoma

24. Teratoma

25. Teratoma

26. Substernal Thyroid Tissues
Develops from cervical goiter or intrathoracic remnants
Can be diagnosed without biopsy by Radioactive iodine scan
No treatment unless symptomatic, usually pressure symptoms

27. Rtrosternal Goiter

28. Neurogenic Tumors Posterior mediastinal location
1/5 of mediastinal tumor
Originate in neural crest
Ganglioheuroma : most common in the textbook
Neurilemmoma – most common in Korea : “Dumb bell Tumor”, neural sheath origin

29. Poosterior Mediastinal Tumor ( Neurillemmoma) )
“Dumb-bell”
Tumor

30. Neurilemmoma(Schwannoma)

31. Para-ganglioma

32. Mesenchymal Tumors Lipoma, Fibroma, Mesothelioma
Superior or Anterior mediastinal location
Diagnosis with CT scan
May cause Hypoglycemia

33. Mediastinitis
Acute : endoscopy complication, Boerhaave’s SD, operation, esophageal rupture, median sternotomy
Chronic : Tbc, histoplasmosis, silicosis, fibrosing mediastinitis

34. Fibrosing Mediastinitis
years
Cough, Dyspnea, or Hemoptysis
Most common cause of Benign SVC syndrome
Almost always remote Histoplasmosis
Plain X-rays may be normal or only minimal changes
Partially calcified Mass on CT is diagnostic

35. Fibrosing Mediastinitis
F/29 with SVC Syndrome by Histoplasmosis

36. Fibrosing Mediastinitis
F/29 with SVC Syndrome by Histoplasmosis

37. Pneumomediastinum Spontaneous : mainly in young male adults
Hamman sign
Present along the Left sternal border
Substernal pain, cough, Dyspnea, Dysphagia

38. Pneumomediastinum

40. Benign Cysts Most Common in Middle mediastinum
20% of mediastinal masses
Less common in Korea
Usually asymptomatic
Bronchogenic cyst(32%), pericardial cyst(35%), enteric cyst(12%), thymic cyst, and thoracic duct cyst

41. Pericardial Cyst Thin-walled, mesothelial cell lining
most common in Right C-P angle
Simple cysts are almost always asymptomatic
Rare cardiac impingement

42. Pericardial Cyst (1)

43. Pericardial Cyst (2)

44. Bronchogenic Cysts 30 - 60% of all mediastinal cysts
Lined by ciliated respiratory epithelium
May contain cartilages or mucous
Communicate with tracheobronchial trees
May become infected
Wheezing, dyspnea, recurrent pulmonary infections

45. Bronchogenic Cyst

46. Bronchogenic Cyst

47. Aortic Aneurysm

49. Thymolipoma

50. Paratracheal Lymphadenopathy

51. Paratracheal Lymphadenopathy with Tracheal Compression

52. Paratracheal Lymphadenopathy

53. Paratracheal Malignant Lymphadenopathy

55. کاخ شهرداری تبریز- میدان شهرداری(ساعت)