Mediastinal Tumors and Cysts.ppt

mediastinaltumorsandcysts sungchulhwang m d dept ofpulmonaryandcriticalcaremedicineajouuniversityschoolofmedicine introduction silentinearlyphasemainlycausepressuresymptomsincidentallydiscoveredbyroutinex raysspecificdiseaseentitiesaccordingtoanatomical andembryologicorigin50 malignantinchildrenwhereas25 inadultsmetastatictumoristhemostcommontumor paincoughhemoptysissvcsyndromehoarsenessdyspneahorner ssyndrome dysphagiapleuraleffusionstridormyatheniagravisphrenicnervepalsychylothorax symptomsandsigns diagnosis chestpa lateralbuckyfilmchestctfluoroscopybronchoscopyesophagogram nabisotopescanningangiographythoracotomyvatsmedistinoscopy commondiseasesofthemediastinum thymoma anteriorandsuperiormediastinummostcommon 20 ofmediastinaltumorinadultsbutrarelyseeninchildren2 3ismalignantequalfrequencyinmalesandfemales30 50yrsvariousclassification lymphocytic epithelial spindlecell50 areasymptomaticassociateddiseases mg 35 prca digerogesd carcinoid eaton lambert agammaglobulinemia myocarditis thyrotoxicosis etc thymoma staging stagei containedwithinanintactcapsulestageii extensionthroughthecapsuletosurroundingfat pleura pericardiumstageiii intrathoracicmetastasisstageiv extrathoracicmetastasis thymoma treatment stagei surgicalresection recurrence2 12 stageii iii surgery radiotherapystageiv multimodality inductionchemotherapy surgery postopradiotherapy5 yearsurvival12 54 notaffectedbythepresenceofmyastheniagravis thymoma thymoma mass ca thymus lymphoma metastaticismostcommon5 10 ismediastinalprimarysecondmoostcommonanteriormediastinalmassinadultsmalignant hodgkin sdx mediastinoscopy thoracotomynab usuallynotconfirmatory hodgkin slymphoma mediastinalwidening germcelltumors anteriormediastinallocationmainlyinlateteens15 ofant med tumorsinadults 24 inchildren1 5ismalignantcysticteratoma dermoidcyst vs solidtumor teratoma solidtumor 1 3malignantradiosensitiveteratoma malignantteratoma seminoma dysgerminomas teratoma teratoma teratoma teratoma substernalthyroidtissues developsfromcervicalgoiterorintrathoracicremnantscanbediagnosedwithoutbiopsybyradioactiveiodinescannotreatmentunlesssymptomatic usuallypressuresymptoms rtrosternalgoiter neurogenictumors posteriormediastinallocation1 5ofmediastinaltumororiginateinneuralcrestganglioheuroma mostcommoninthetextbookneurilemmoma mostcommoninkorea dumbbelltumor neuralsheathorigin poosteriormediastinaltumor neurillemmoma dumb bell tumor neurilemmoma schwannoma para ganglioma mesenchymaltumors lipoma fibroma mesotheliomasuperiororanteriormediastinallocationdiagnosiswithctscanmaycausehypoglycemia mediastinitis acute endoscopycomplication boerhaave ssd operation esophagealrupture mediansternotomychronic tbc histoplasmosis silicosis fibrosingmediastinitis fibrosingmediastinitis 20 40yearscough dyspnea orhemoptysismostcommoncauseofbenignsvcsyndromealmostalwaysremotehistoplasmosisplainx raysmaybenormaloronlyminimalchangespartiallycalcifiedmassonctisdiagnostic fibrosingmediastinitis f 29withsvcsyndromebyhistoplasmosis fibrosingmediastinitis f 29withsvcsyndromebyhistoplasmosis pneumomediastinum spontaneous mainlyinyoungmaleadultshammansignpresentalongtheleftsternalbordersubsternalpain cough dyspnea dysphagia pneumomediastinum benigncysts mostcommoninmiddlemediastinum20 ofmediastinalmasseslesscommoninkoreausuallyasymptomaticbronchogeniccyst 32 pericardialcyst 35 entericcyst 12 thymiccyst andthoracicductcyst pericardialcyst thin walled mesothelialcellliningmostcommoninrightc panglesimplecystsarealmostalwaysasymptomaticrarecardiacimpingement pericardialcyst 1 pericardialcyst 2 bronchogeniccysts 30 60 ofallmediastinalcystslinedbyciliatedrespiratoryepitheliummaycontaincartilagesormucouscommunicatewithtracheobronchialtreesmaybecomeinfectedwheezing dyspnea recurrentpulmonaryinfections bronch