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Mediastinal tumor

Thymoma - mediastinal; Lymphoma - mediastinal

 

Mediastinal tumors are growths that form in the mediastinum. This is an area in the middle of the chest that separates the lungs.

Causes

 

The mediastinum is the part of the chest that lies between the sternum and the spinal column, and between the lungs. This area contains the heart, large blood vessels, windpipe (trachea), thymus gland, esophagus, and connective tissues. The mediastinum is divided into three sections:

  • Anterior (front)
  • Middle
  • Posterior (back)

Mediastinal tumors are rare.

The most common location for tumors in the mediastinum depends on the age of the patient. In children, tumors are more common in the posterior mediastinum. These tumors often begin in the nerves and are non-cancerous (benign).

Most mediastinal tumors in adults occur in the anterior mediastinum and are usually cancerous (malignant) lymphomas, germ cell tumors, or thymomas. These tumors are most common in people ages 30 to 50.

 

Symptoms

 

Almost half of mediastinal tumors cause no symptoms and are found on a chest x-ray done for another reason. Symptoms that do occur are due to pressure on (compression of) local structures and may include:

  • Chest pain
  • Chills
  • Cough
  • Coughing up blood (hemoptysis)
  • Fever
  • Hoarseness
  • Night sweats
  • Shortness of breath

 

Exams and Tests

 

A medical history and physical examination may show:

  • Fever
  • High-pitched breathing sound (stridor)
  • Swollen or tender lymph nodes (lymphadenopathy)
  • Unintentional weight loss
  • Wheezing

Further tests that may be done include:

  • Chest x-ray
  • CT-guided needle biopsy
  • CT scan of the chest
  • Mediastinoscopy with biopsy
  • MRI of the chest

 

Treatment

 

Treatment for mediastinal tumors depends on the type of tumor and symptoms:

  • Thymic cancers are treated with surgery. It may be followed by radiation or chemotherapy, depending on the stage of the tumor and the success of the surgery.
  • Germ cell tumors are usually treated with chemotherapy.
  • For lymphomas, chemotherapy is the treatment of choice, and is possibly followed by radiation.
  • For neurogenic tumors of the posterior mediastinum, surgery is the main treatment.

 

Outlook (Prognosis)

 

The outcome depends on the type of tumor. Different tumors respond differently to chemotherapy and radiation.

 

Possible Complications

 

Complications of mediastinal tumors include:

  • Spinal cord compression
  • Spread to nearby structures such as the heart, lining around the heart (pericardium), and great vessels (aorta and vena cava)

Radiation, surgery, and chemotherapy can all have serious complications.

 

When to Contact a Medical Professional

 

Call your health care provider if you notice symptoms of a mediastinal tumor.

 

 

References

Park DR, Vallieres E. Tumors and cysts of the mediastinum. In: Mason RJ, Murray JF, Broaddus VC, et al., eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 76.

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          Review Date: 5/29/2014

          Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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