Mediastinal Tumor

Overview

What are mediastinal tumors?

Tumors (also called neoplasms) are masses of cells. They can be benign (not cancer) or malignant (cancer). Mediastinal tumors are growths that form in the area of the chest that separates the lungs. This area, called the mediastinum, is surrounded by the breastbone in front, the spine in back, and the lungs on each side. The mediastinum contains the heart, aorta, esophagus, thymus, trachea, lymph nodes and nerves. The thymus is an organ that is part of the immune system. The lymph system, or lymphatic system, is also part of the immune system and helps to protect the body.

Who is affected by mediastinal tumors?

In general, mediastinal tumors are rare. Mediastinal tumors are usually diagnosed in patients aged 30 to 50 years, but they can develop at any age and form from any tissue that exists in or passes through the chest cavity.

The location of tumors within the mediastinum varies according to the age of the patient. In children, tumors are commonly found in the posterior (back) mediastinum. These mediastinal tumors often begin in the nerves and are typically not cancerous.

In adults, most mediastinal tumors occur in the anterior (front) mediastinum and are generally malignant (cancerous) lymphomas or thymomas.

Is a mediastinal tumor serious?

Due to their location, mediastinal tumors that are not treated can cause serious problems, even if they are not cancerous. These problems include spreading to the heart, pericardium (the lining around the heart), and great vessels (the aorta and vena cava). Tumors located in the posterior (back) mediastinum can cause compression of the spinal cord.

Symptoms and Causes

What causes mediastinal tumors?

There are several types of mediastinal tumors, with their causes linked to where they form in the mediastinum.

Anterior (front) mediastinum
  • Lymphoma: These malignant tumors include both Hodgkin's disease and non Hodgkin's lymphoma.
  • Thymoma and thymic cyst: These are the most common causes of a thymic mass. The majority of thymomas are benign and surrounded by a fibrous capsule. However, about 30% of these may be more aggressive and grow through the sac into other tissue.
  • Germ cell: The majority of germ cell neoplasms (60 to 70%) are benign and are found in both males and females.
  • Thyroid mass mediastinal: This is usually a benign growth, such as a goiter.
Middle mediastinum
  • Bronchogenic cyst : This is a benign growth with respiratory origins.
  • Lymphadenopathy mediastinal: This is an enlargement of the lymph nodes.
  • Pericardial cyst: This is a benign growth that results from an "out-pouching" of the pericardium (the heart's lining).
  • Tracheal tumors: These can be benign or malignant.
  • Esophageal tumors: These can be benign or malignant.
  • Esophageal abnormalities: These include achalasia esophageal, diverticulum, and hiatal hernia.
  • Vascular abnormalities: These include aortic aneurysm and aortic dissection.
Posterior (back) mediastinum
  • Neurogenic tumors: The most common cause of posterior mediastinal tumors, these are classified as nerve sheath neoplasms, ganglion cell neoplasms, and paraganglionic cell neoplasms. Approximately 70% of neurogenic neoplasms are benign.
  • Lymphadenopathy: This refers to an enlargement of the lymph nodes.
  • Extramedullary haematopoiesis: This is a rare cause of masses that form from bone marrow expansion and are associated with severe anemia.
  • Neuroenteric cyst: This is a rare growth, which involves both neural and gastrointestinal elements.
  • Paravertebral abnormalities: These include infectious, malignant and traumatic abnormalities of the thoracic spine.
  • Vascular abnormalities: These include aortic aneurysms.

What are the symptoms of a mediastinal tumor?

Almost 40% of people who have mediastinal tumors experience no symptoms. Most of the growths are often discovered on a chest X-ray that is performed for another reason. Symptoms often result from the pressure put by the tumors onto surrounding structures, such as the spinal cord, heart or the pericardium (the heart's lining), and may include:

  • Cough
  • Shortness of breath
  • Chest pain (somewhat rare)
  • Flushing
  • Fever
  • Chills
  • Night sweats
  • Coughing up blood
  • Hoarseness
  • Unexplained weight loss
  • Lymphadenopathy (swollen or tender lymph nodes)
  • Wheezing
  • Stridor (high-pitched and noisy breathing, which could mean a blockage)
  • Eye issues (drooping eyelid, small pupil) on one side of the face

Diagnosis and Tests

How is a mediastinal tumor diagnosed?

The tests most commonly used to diagnose and evaluate a mediastinal tumor include:

  • Computed tomography (CT) with an IV contrast agent
  • Blood tests
  • Ultrasound
  • Needle biopsy or aspiration or CT-guided needle biopsy
  • Chest X-ray
  • Magnetic resonance imaging (MRI) of the chest
  • Esophagoscopy
  • Bronchoscopy
  • Mediastinoscopy with biopsy. This method calls for a lighted tube to be inserted through the neck to allow for tissue removal.

Management and Treatment

How are mediastinal tumors treated?

The treatment used for mediastinal tumors depends on the type of tumor and its location:

  • Thymomas require surgical resection with possible radiation to follow. This can be accomplished by minimally invasive techniques such as thoracoscopy or robotic resection or by median sternotomy, an open approach that splits the breastbone.
  • Thymic cancers often require surgery, radiation and chemotherapy.
  • Lymphomas, once diagnosed, are treated with chemotherapy followed by radiation. Surgery may be required to obtain diagnostic tissue.
  • Neurogenic tumors found in the posterior (back) mediastinum are treated surgically.
  • Some masses, if they are not cancerous and are not causing problems, are treated by watchful waiting, which means they are monitored over time.

What are the benefits of minimally invasive surgery to treat mediastinal tumors?

As compared with traditional surgery, patients who undergo minimally invasive surgery, such as video-assisted thoracoscopy (VATS) mediastinoscopy, experience:

  • Decreased postoperative pain
  • Shorter hospital stay
  • More rapid recovery and return to work

Other possible benefits include reduced risk of infection and less bleeding.

What are the risks of minimally invasive surgery to treat mediastinal tumors?

The possible complications of minimally invasive surgical treatment include:

  • Damage to the surrounding area, which may include the heart, pericardium (the heart's lining) or spinal cord.
  • Bleeding requiring transfusion and conversion to a larger incision.
  • Pleural effusion (a collection of fluid between the thin layers of tissue lining the lung and the wall of the chest cavity, or pleura)
  • Postoperative drainage
  • Postoperative infection or bleeding

Your healthcare team will provide specific instructions to prepare you for each treatment or procedure. They will also provide specific instructions for your recovery and return to work, including guidelines for activity, driving, incision care and diet.

Chemotherapy can cause side effects depending on the type of medication used. Chemotherapy and radiation therapy might be used before surgery to try to make the mass smaller in size.

In general, treatment complications include problems with breathing pain and recurrence of cancer.

Prevention

How can I prevent mediastinal tumors?

Mediastinal masses cannot be prevented. However, you can improve your treatment chances by finding any tumor early. If you have shortness of breath, coughing, or other symptoms lasting longer than two weeks, contact your doctor.

Outlook / Prognosis

What is the outlook for people with mediastinal tumors?

Every type of tumor is different, and the outlook varies with the type of tumor, whether or not the tumor is cancerous, and the general health of the person involved.

Last reviewed by a Cleveland Clinic medical professional on 04/09/2019.

References

  • Society of Thoracic Surgeons. Accessed 4/9/2019.Mediastinal Tumors. (https://ctsurgerypatients.org/lung-esophageal-and-other-chest-diseases/mediastinal-tumors)
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