TumorsoftheMediastinum.ppt

Primary Tumors of Mediastinum The mediastinum is an anatomic division of the thorax extending from the diaphragm to the thoracic inlet. Mediastinal disorders present as a number of clinical features. Many cases are asymptomatic, and the disorder is identified on routine chest radiographs. Most patients have clinical features related to local involvement of adjacent structures, tumor secretory factors, or immunologic factors. Anatomy of Mediastinum Borders: Superior: the thoracic inlet Inferior: the diaphragm Anterior: the sternum Posterior: the vertebral column Lateral: the parietal pleura Right mediastinal view Components of Mediastinal Compartments I. Anterior Mediastinal Masses Differential Diagnosis of a Mass Lesion in the Anterior Mediastinal Compartment. Neoplastic Thyroid Substernal goiter Ectopic thyroid tissue Thymus Thymic hyperplasia Thymoma Thymic carcinoma Thymic carcinoid Thymic cysts Teratoma Mature teratoma Immature teratoma Lymphoma THYMIC TUMORS Thymic Masses. Thymic hyperplasia Thymoma Thymic carcinoma Thymic neuroendocrine tumors Carcinoid Small-cell carcinoma Thymic cysts (nonthymomatous) Thymolipoma Metastases to the thymus Thymoma Thymomas represent the most common thymic tumor, and approximately 95% are located in the anterior mediastinum. They are of surgical interest both because excision is the primary therapy and because of the interesting association with myasthenia gravis (MG), a disease the clinical course of which can be favorably influenced by thymectomy. Pathology of Thymoma Thymomas are derived from thymic epithelial cells, but most contain varying mixes of epithelial cells and lymphocytes. Traditional histological classifications have therefore grouped thymomas according to cytological make-up: (1) predominantly lymphocytic, (2) predominantly epithelial, and (3) mixed. Classification Schemes for Thymoma Presentation of Thym