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Çinar HG, Gulmez AO, Üner Ç, Aydin S. Mediastinal lesions in children. World J Clin Cases 2023; 11:2637-2656. [PMID: 37214576 PMCID: PMC10198114 DOI: 10.12998/wjcc.v11.i12.2637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/17/2023] [Accepted: 03/24/2023] [Indexed: 04/25/2023] Open
Abstract
The mediastinum is where thoracic lesions most frequently occur in young patients. The histological spectrum of diseases caused by the presence of several organs in the mediastinum is broad. Congenital lesions, infections, benign and malignant lesions, and vascular diseases are examples of lesions. Care should be taken to make the proper diagnosis at the time of diagnosis in order to initiate therapy promptly. Our task is currently made simpler by radiological imaging techniques.
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Affiliation(s)
- Hasibe Gökçe Çinar
- Department of Pediatric Radiology, Ankara Etlik City Hospital, Ankara 06000, Turkey
| | - Ali Osman Gulmez
- Department of Radiology, Erzincan Binali Yıldırım University Faculty of Medicine, Erzincan 24100, Turkey
| | - Çiğdem Üner
- Department of Pediatric Radiology, Ankara Etlik City Hospital, Ankara 06000, Turkey
| | - Sonay Aydin
- Department of Radiology, Erzincan Binali Yıldırım University Faculty of Medicine, Erzincan 24100, Turkey
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2
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Benjamin SR, Rao VM, Kodiatte TA, Adhikari T. Rib malignancies masquerading as benign mediastinal tumours. Indian J Thorac Cardiovasc Surg 2023; 39:72-75. [PMID: 36590047 PMCID: PMC9794664 DOI: 10.1007/s12055-022-01421-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 11/07/2022] Open
Abstract
Mediastinal tumours are commonly encountered in general thoracic surgery practice. Benign tumours like thymoma and teratoma often need direct surgical resection if resectable. Pre-operative biopsy is not recommended. We report 2 cases which were radiologically diagnosed as thymoma and teratoma turned out to be Ewing sarcoma and chondrosarcoma respectively after surgical excision. This has challenged the notion whether biopsy is really not needed. More elaborate studies are needed to find out tumour characteristics which would warrant a biopsy even if they are resectable. In our cases, pre-operative biopsy would have changed the line of management in both patients. This has led to a change in institutional protocol that now, we do biopsy for any mediastinal tumour more than 8 cm and abutting the chest wall.
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Affiliation(s)
- Santhosh Regini Benjamin
- The Department of Cardiothoracic Surgery, The Christian Medical College, Vellore, Tamil Nadu India 632004
| | - Vinay Murahari Rao
- The Department of Cardiothoracic Surgery, The Christian Medical College, Vellore, Tamil Nadu India 632004
| | - Thomas Alex Kodiatte
- The Department of Pathology, The Christian Medical College, Vellore, Tamil Nadu India 632004
| | - Twisha Adhikari
- The Department of Pathology, The Christian Medical College, Vellore, Tamil Nadu India 632004
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3
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Garrana SH, Rosado-de-Christenson ML. Imaging of the Anterior/Prevascular Mediastinum. Radiol Clin North Am 2021; 59:155-168. [PMID: 33551078 DOI: 10.1016/j.rcl.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Prevascular mediastinal masses include a wide range of benign and malignant entities. Localization of mediastinal masses to specific compartments together with characteristic imaging findings and demographic and clinical information allows formulation of a focused differential diagnosis. Radiologists may use these methods to distinguish between surgical and nonsurgical cases and thus inform patient management and have an impact on outcomes. Treatment of choice varies based on the pathology, ranging from no intervention or serial imaging follow-up to surgical excision, chemotherapy, and/or radiation.
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Affiliation(s)
- Sherief H Garrana
- Department of Radiology, Saint Luke's Hospital of Kansas City, 4401 Wornall Road, Kansas City, MO 64111, USA; University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA.
| | - Melissa L Rosado-de-Christenson
- Department of Radiology, Saint Luke's Hospital of Kansas City, 4401 Wornall Road, Kansas City, MO 64111, USA; University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA
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4
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Lee SH, Yoon SH, Nam JG, Kim HJ, Ahn SY, Kim HK, Lee HJ, Lee HH, Cheon GJ, Goo JM. Distinguishing between Thymic Epithelial Tumors and Benign Cysts via Computed Tomography. Korean J Radiol 2020; 20:671-682. [PMID: 30887749 PMCID: PMC6424822 DOI: 10.3348/kjr.2018.0400] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/06/2018] [Indexed: 12/18/2022] Open
Abstract
Objective To investigate whether computed tomography (CT) and fluorine-18-labeled fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) may be applied to distinguish thymic epithelial tumors (TETs) from benign cysts in the anterior mediastinum. Materials and Methods We included 262 consecutive patients with pathologically proven TETs and benign cysts 5 cm or smaller who underwent preoperative CT scans. In addition to conventional morphological and ancillary CT findings, the relationship between the lesion and the adjacent mediastinal pleura was evaluated qualitatively and quantitatively. Mean lesion attenuation was measured on CT images. The maximum standardized uptake value (SUVmax) was obtained with FDG-PET scans in 40 patients. CT predictors for TETs were identified with multivariate logistic regression analysis. For validation, we assessed the diagnostic accuracy and inter-observer agreement between four radiologists in a size-matched set of 24 cysts and 24 TETs using a receiver operating characteristic curve before and after being informed of the study findings. Results The multivariate analysis showed that post-contrast attenuation of 60 Hounsfield unit or higher (odds ratio [OR], 12.734; 95% confidence interval [CI], 2.506–64.705; p = 0.002) and the presence of protrusion from the mediastinal pleura (OR, 9.855; 95% CI, 1.749–55.535; p = 0.009) were the strongest CT predictors for TETs. SUVmax was significantly higher in TETs than in cysts (5.3 ± 2.4 vs. 1.1 ± 0.3; p < 0.001). After being informed of the study findings, the readers' area under the curve improved from 0.872–0.955 to 0.949–0.999 (p = 0.066–0.149). Inter-observer kappa values for protrusion were 0.630–0.941. Conclusion Post-contrast CT attenuation, protrusion from the mediastinal pleura, and SUVmax were useful imaging features for distinguishing TETs from cysts in the anterior mediastinum.
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Affiliation(s)
- Sang Hyup Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea.
| | - Ju Gang Nam
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hyung Jin Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Su Yeon Ahn
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea.,Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hee Kyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hyun Ju Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hwan Hee Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Ikezoe J, Sone S, Morimoto S, Takashima S, Arisawa J, Hamada S, Nakahara K, Kojiro N, Ito M, Kozuka T. Computed Tomography Reveals Atypical Localization of Benign Mediastinal Tumors. Acta Radiol 2016. [DOI: 10.1177/028418518903000211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Computed tomographic appearances of 147 surgically proven mediastinal tumors (113 benign and 34 malignant lesions) were evaluated paying special attention to their localization or extension. Ten of the 113 benign lesions (9%) showed atypical or unique localization or extension, and were divided into three groups. In the first group, two lymphangiomas and one bronchogenic cyst spread over both the precardiovascular and the retrocardiovascular compartments, mimicking a malignant lesion. In the second group, the single cases of thymic hypertrophy, thymic cyst, schwannoma, and pericardial cyst were located atypically in the retrocardiovascular compartment. In the last group, two esophageal leiomyomas and one esophageal duplication showed upward and downward longitudinal extension beyond the azygos arch and the aortic arch.
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6
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Ivancev K, Halldorsdottir A, Laurin S, Sandström S, Békássy A, Garwics S, Wiebe T. Computed Tomography in the Diagnosis and Treatment of Mediastinal Abnormalities in Children. Acta Radiol 2016. [DOI: 10.1177/028418518802900123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Thirty-one children with mediastinal abnormalities—14 malignant lymphomas, 4 other primary malignancies, one metastatic and 12 benign lesions—were examined one or several times using CT, which proved to be effective especially for cysts (5 patients), ductus arteriosus aneurysm (2 patients), and intrathoracic liver (one patient). It also supplied important diagnostic information regarding the extent of disease in malignant thymoma (one patient), in neurinoma (one patient), and in Hodgkin's lymphoma (5 patients). It was found to be useful in the monitoring of treatment of patients with lymphomas, in which a small residue, probably a fibrotic remnant, was invariably seen after completion of chemotherapy and irradiation. It was concluded that when the residue was enlarged, the possibility of relapse and even thymic hyperplasia should be considered. However, if CT was performed under general anaesthesia pseudo-widening of the anterior mediastinum could simulate recurrence. Surgical biopsy was found to be necessary in these cases because fine-needle aspiration biopsy was unsuccessful.
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7
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Blomlie V, Lien HH, Fosså SD, Jacobsen AB, Stenwig AE. CT in Primary Malignant Germ Cell Tumors of the Retroperitoneum. Acta Radiol 2016. [DOI: 10.1177/028418519103200215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Malignant germ cell tumors may exist as a primary entity in the retroperitoneum. In a CT study of 14 males with this condition (2 seminomas and 12 non-seminomatous tumors) all masses were large, lobulated and of mixed density. Fat plane obliteration against adjacent structures was frequent. The aorta was embedded in 9 patients and the inferior vena cava was affected in 7, 2 of whom had signs of compromised caval blood flow. Distant metastases were found in the lungs (7 patients), liver (n = 4), posterior mediastinum (n = 3), and in brain and supraclavicular lymph nodes in one patient each. Serum biomarkers were elevated in 11 patients. An extragonadal germ cell tumor should be considered when CT of the abdomen reveals a large retroperitoneal mass with mixed density.
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Blomlie V, Lien HH, Fosså SD, Jacobsen AB, Stenwig AE. Computed Tomography in Primary Non-Seminomatous Germ Cell Tumors of the Mediastinum. Acta Radiol 2016. [DOI: 10.1177/028418518802900306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Germ cell tumor exists as a primary entity in the anterior mediastinum. In a CT study of two males and one female with primary non-seminomatous germ cell tumors all masses were large and lobulated with a mixed density. The fat planes were for the most part obliterated. A high attenuating border was present around parts of the tumor in all three cases, and the pleura-lung interfaces were irregular. One patient had pericardial and left pleural effusions as well as tumor invasion of the anterior chest wall. An extragonadal germ cell tumor should be considered when CT of the thorax reveals a large mass in the anterior mediastinum of a young adult.
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Mori K, Eguchi K, Moriyama H, Miyazawa N, Kodama T. Computed Tomography of Anterior Mediastinal Tumors. Acta Radiol 2016. [DOI: 10.1177/028418518702800405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Computed tomographic (CT) features in 10 patients with germ cell tumor of the mediastinum and 15 with thymoma were compared with surgically resected specimens. The CT findings of the internal structure of tumors were the most important factor for specific diagnosis. Germ cell tumors showed a round mass without distinct lobulation, frequently with calcification appearing as a globular shape, and especially in benign tumors as an arched shape along the wall. Homogeneous low density masses (near-water) with a thick wall were benign and non-homogeneous density masses (a mixture of near-water and soft tissue) were malignant. Thymoma usually showed a solid mass with lobulation and sometimes had an eggshell type of calcification in the tumor. Therefore, CT is of importance in the diagnosis of anterior mediastinal masses.
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10
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Qi YU, Zhang C, Liu D, Yang Y, Zhao S. Situs inversus totalis with a mature teratoma of the posterior mediastinum: A case report. Oncol Lett 2016; 11:1135-1137. [PMID: 26893706 DOI: 10.3892/ol.2015.3994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 10/21/2015] [Indexed: 11/06/2022] Open
Abstract
Situs inversus totalis is an unusual disease with a low incidence. The co-existence of situs inversus totalis with a teratoma is extremely rare. To the best of our knowledge, there is no data on the association between situs inversus totalis and teratoma in the literature. The present study therefore describes the first such case in a 23-year-old female. The patient presented with intermittent chest tightness, which had lasted for ~3 years. Following radiological examination, the patient was diagnosed with situs inversus totalis and a mature teratoma in the posterior mediastinum. Surgical resection was performed to remove the teratoma and the patient subsequently made a full recovery. Follow-up X-ray and computed tomography examinations were performed 6 months after surgery, which revealed no disease recurrence.
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Affiliation(s)
- Y U Qi
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Chunyang Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Donglei Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Yang Yang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Song Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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11
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Tian L, Liu LZ, Cui CY, Zhang WD, Kuang YL. CT findings of primary non-teratomatous germ cell tumors of the mediastinum—A report of 15 cases. Eur J Radiol 2012; 81:1057-61. [DOI: 10.1016/j.ejrad.2011.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 02/01/2011] [Indexed: 10/18/2022]
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13
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Parkinson CA, Hatcher HM, Earl HM, Ajithkumar TV. Multidisciplinary management of malignant ovarian germ cell tumours. Gynecol Oncol 2011; 121:625-36. [PMID: 21353692 DOI: 10.1016/j.ygyno.2010.12.351] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 12/17/2010] [Accepted: 12/19/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Malignant ovarian germ cell tumours (MOGCT) are rare cancers of young women. Limited prospective trials exist from which evidence-based management can be developed. This review summarizes the available literature concerning MOGT in order to provide the clinician with information relevant to their multidisciplinary management. METHODS MEDLINE was searched between 1966 and 2010 for all publications in English where the studied population included women diagnosed with malignant ovarian germ cell tumours. RESULTS The majority of patients can be cured with fertility-preserving surgery with or without combination chemotherapy. Long term survival approaches 100% in early stage disease and is approximately 75% in advanced stage disease. Most studies suggest that the treatment has little, if any, effect on future fertility and limited data suggest that there is no adverse effect on the future quality of life. CONCLUSION MOGCTs are rare tumours of young women the majority of which can be successfully treated with fertility-preserving surgery with or without chemotherapy with preservation of reproductive function. Minimisation of chemotherapy in good prognostic groups and improved treatment in resistant and relapsed MOGCT are important goals for the future. Further studies are needed to quantify the late adverse effects of treatment in long term survivors.
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Affiliation(s)
- C A Parkinson
- Medical Oncology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, UK.
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Abstract
OBJECTIVE The purpose of this article is to describe the key imaging features of primary and metastatic extragonadal germ cell tumors in adults. CONCLUSION Extragonadal germ cell tumors primarily affect men during the third and fourth decades of life. Their imaging characteristics are nonspecific, and extragonadal germ cell tumors should always be included in the differential diagnosis of a midline anterior mediastinal or retroperitoneal mass. Levels of human chorionic gonadotropin or α-fetoprotein or both may be elevated, depending on the histologic subtype.
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15
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Agarwal G, Kar DK. Teratoma of the anterior mediastinum presenting as a cystic neck mass: a case report. J Med Case Rep 2008; 2:23. [PMID: 18221571 PMCID: PMC2259367 DOI: 10.1186/1752-1947-2-23] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Accepted: 01/28/2008] [Indexed: 12/03/2022] Open
Abstract
Introduction Teratomas of anterior mediastinum are rare tumors and are often slow growing, asymptomatic and detected incidentally on chest imaging. Results of surgical resection are very satisfactory. Case presentation A 19-years old male presented with an asymptomatic cystic neck mass. X-ray and CT scan of chest and neck showed an extrathyroidal multi-septate, predominantly cystic neck mass, that was continuous with a solid intrathoracic mass extending up to the level of right atrium and which contained areas of calcification and cystic necrosis. The mediastinal structures did not show any features of compression or infiltration. Fine needle aspiration cytology from the neck mass was suggestive of a dermoid cyst. In view of the extent and uncertain pathological nature of the tumor, it was excised via a combined cervical and trans-sternal route. Histo-pathology of the resected specimen confirmed the diagnosis of a mature cystic teratoma. The patient made an uneventful recovery, and after five years of follow-up, he has been symptom free with no clinical or radiological evidence of recurrent disease. We discuss the role of imaging and the need for surgical treatment to avoid possible catastrophic complications in patients with cervical and mediastinal masses of uncertain histological nature. Conclusion A mediastinal teratoma may rarely present as a cystic neck swelling due to its cephalad extension. This entity needs to be considered in cases where clinical and investigative work-up fail to provide a convincing clue to a primary neck pathology as cause of a cystic neck swelling.
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Affiliation(s)
- Gaurav Agarwal
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India.
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17
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Ueno T, Tanaka YO, Nagata M, Tsunoda H, Anno I, Ishikawa S, Kawai K, Itai Y. Spectrum of germ cell tumors: from head to toe. Radiographics 2004; 24:387-404. [PMID: 15026588 DOI: 10.1148/rg.242035082] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Germ cell tumors (GCTs) occur most frequently in the gonads and are relatively rare in other sites, such as the pineal gland, neurohypophysis, mediastinum, and retroperitoneum. GCTs are thought to originate from primordial germ cells, which migrate to the primitive gonadal glands in the urogenital ridge. Extragonadal GCTs might also originate from these cells when the cells are sequestered during their migration. Pathologic subtypes of GCTs vary, and the prevalence of mixed tumors is high. These factors produce a diversity of radiologic findings and make prospective radiologic diagnosis difficult in many cases. However, similar radiologic findings have been observed in pathologically equivalent tumors in varying sites. Seminomas appear as uniformly solid, lobulated masses with fibrovascular septa that enhance intensely. Nonseminomatous GCTs appear as heterogeneous masses with areas of necrosis, hemorrhage, or cystic degeneration. Fat and calcifications are hallmarks of teratomas, most of which are benign. In immature teratomas, scattered fat and calcification within larger solid components are occasionally seen. These imaging characteristics reflect the pathologic features of each tumor, and histologically similar GCTs at varying sites have similar radiologic features. Knowledge of the pathologic appearances of GCTs and their corresponding radiologic appearances will allow radiologists to diagnose these tumors correctly.
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Affiliation(s)
- Teruko Ueno
- Department of Radiology, Tsukuba University Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan.
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Strollo DC, Rosado-de-Christenson ML. Primary mediastinal malignant germ cell neoplasms: imaging features. CHEST SURGERY CLINICS OF NORTH AMERICA 2002; 12:645-58. [PMID: 12471868 DOI: 10.1016/s1052-3359(02)00026-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Mature teratomas are the most frequent primary mediastinal GCN. These are spherical multilocular cystic masses with thin, soft tissue septa and frequent internal fat attenuation. Primary mediastinal malignant GCNs are rare and should be included in the differential diagnosis of anterior mediastinal masses in young adult males. Seminomas are typically homogeneous masses indistinguishable from lymphomas. Radiologically nonseminomatous malignant germ cell neoplasms are large, locally invasive heterogeneous masses with central low-attenuation and frond-like peripheral soft tissue. Gonadal primary malignancy and intervening abdominal lymph node involvement should be excluded. Tumor markers play a crucial role in the initial evaluation of anterior mediastinal masses in these patients and in evaluating response to therapy and possible recurrence. Follow-up imaging is helpful in detection and characterization of residual neoplasm.
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Affiliation(s)
- Diane C Strollo
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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Affiliation(s)
- J D Hainsworth
- Sarah Cannon Cancer Center Centennial Medical Center, Nashville, TN 37203, USA
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20
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Hall TB, Drury AE, MacVicar D. Uncommon malignant diseases of the thorax. IMAGING 2000. [DOI: 10.1259/img.12.2.120130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Erasmus JJ, McAdams HP, Donnelly LF, Spritzer CE. MR IMAGING OF MEDIASTINAL MASSES. Magn Reson Imaging Clin N Am 2000. [DOI: 10.1016/s1064-9689(21)00042-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Strollo DC, Rosado de Christenson ML, Jett JR. Primary mediastinal tumors. Part 1: tumors of the anterior mediastinum. Chest 1997; 112:511-22. [PMID: 9266892 DOI: 10.1378/chest.112.2.511] [Citation(s) in RCA: 200] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Primary anterior mediastinal neoplasms comprise a diverse group of tumors and account for 50% of all mediastinal masses. Thymomas are most common and can be locally invasive and associated with parathymic syndromes. Thymic carcinomas and thymic carcinoids are rare malignancies with a propensity for local invasion and distant metastases. Thymolipomas are benign thymic tumors. The mediastinal germ cell tumors are a heterogeneous group of benign and malignant neoplasms. Mediastinal lymphangiomas are rare tumors and predominantly occur in young children. In contrast, mediastinal goiters are relatively common in adults. Mediastinal parathyroid adenomas are an uncommon cause of persistent hyperparathyroidism and rarely cause a discernible mass. The clinical, radiologic, and therapeutic aspects of the most common masses are reviewed.
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Affiliation(s)
- D C Strollo
- Department of Radiology, University of Pittsburgh Medical Center, USA
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24
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Meza MP, Benson M, Slovis TL. IMAGING OF MEDIASTINAL MASSES IN CHILDREN. Radiol Clin North Am 1993. [DOI: 10.1016/s0033-8389(22)02607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Teratomas of diverse sites in infants and children have been seen in this institution, but this is the first primary germ-cell tumour of the mediastinum in a child reported from Northern Nigeria. The patient had an infected teratodermoid tumour of the mediastinum which was erroneously diagnosed as chronic empyema thoracis.
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Affiliation(s)
- P T Nmadu
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
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Abstract
We describe a chondrosarcoma presenting as an anterior mediastinal mass. The tumour was unusual in that it simulated more commonly occurring mediastinal tumours. There was relatively little destruction of the anterior chest wall and very little calcification within the lesion.
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Affiliation(s)
- G W Phillips
- Department of Radiology, Repatriation General Hospital Heidelberg, Victoria, Australia
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Brown K, Aberle DR, Batra P, Steckel RJ. Current use of imaging in the evaluation of primary mediastinal masses. Chest 1990; 98:466-73. [PMID: 2198143 DOI: 10.1378/chest.98.2.466] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A wide variety of lesions occur in the mediastinum in patients of every age. Twenty five to 50 percent of these primary mediastinal masses may be malignant, making early diagnosis and therapy crucial. Since most arise from normal structures in the region, localization of lesions to compartments of the mediastinum may assist in diagnosis. This article reviews imaging techniques for lesions originating in the mediastinum.
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Affiliation(s)
- K Brown
- Department of Radiological Sciences, UCLA School of Medicine 90024
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28
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Sham JS, Chan FL, Lau WH, Choi PH, Choy D. Primary mediastinal endodermal sinus tumors: CT evaluation. Clin Imaging 1989; 13:299-304. [PMID: 2598112 DOI: 10.1016/0899-7071(89)90063-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Five patients with primary mediastinal endodermal sinus tumor have been evaluated by computed tomography (CT). The tumors were all located in the anterior mediastinum. Prechemotherapy CT demonstrated large, irregularly enhancing inhomogeneous masses without fat components. Calcification was visualized in two tumors. Some parts of the pleura-lung interface were irregular in four cases. Obliteration of fat planes to pericardium and chest wall was evident in all cases, and there was infiltration of intercostal muscles in four. Postchemotherapy CT in two patients who responded to chemotherapy showed either newly developed cystic lesions or cystic change of the original mediastinal mass. The cystic masses had more regular borders, a homogeneous hypodense center, and a smooth peripheral rim of contrast-enhancing tissue.
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Affiliation(s)
- J S Sham
- Department of Radiotherapy, Queen Mary Hospital, Hong Kong
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29
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Brown K, Collins JD, Batra P, Steckel RJ, Kagan AR. Mediastinal germ cell tumor in a young woman. MEDICAL AND PEDIATRIC ONCOLOGY 1989; 17:164-7. [PMID: 2704337 DOI: 10.1002/mpo.2950170218] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Primary mediastinal germ cell malignancies are uncommon neoplasms, usually presenting in young men. We review a case of a primary mediastinal seminoma occurring in a 23-year-old woman. The differential diagnosis, work-up and therapy for these lesions is discussed with emphasis on the role of magnetic resonance imaging in the evaluation of anterior mediastinal masses.
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Affiliation(s)
- K Brown
- Department of Radiological Sciences, UCLA School of Medicine 90024
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30
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Abstract
Mediastinal masses occur in both men and women of every age, and close to half of affected patients are asymptomatic. Screening of asymptomatic persons is not economically feasible. Symptomatic patients should be evaluated initially with posteroanterior and lateral chest radiographs. Additional imaging techniques may be required in patients suspected of having a mediastinal mass, when there is a questionable abnormality seen on chest radiographs or when local or systemic symptoms suggest a mediastinal mass. These techniques include oblique views, over-penetrated radiographs, and fluoroscopy of the chest. Computerized tomography of the chest is the imaging modality of choice for further assessment of a mediastinal mass. It can also be an important adjunct in radiotherapy portal planning. The use of other imaging modalities depends on the location of the tumor, the equipment available, and the expertise of local radiologists. In following up treated patients for disease recurrence, periodic chest radiographs are usually sufficient. Computerized tomography scans, because of their expense, should only be obtained as a baseline after completion of therapy or in patients with a suspected relapse.
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Affiliation(s)
- P Batra
- Department of Radiological Sciences, UCLA School of Medicine 90024
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31
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Rendina EA, Venuta F, Ceroni L, Martelli M, Gualdi G, Caterino M, Ricci C. Computed tomographic staging of anterior mediastinal neoplasms. Thorax 1988; 43:441-5. [PMID: 3420555 PMCID: PMC461307 DOI: 10.1136/thx.43.6.441] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Sixty patients with anterior mediastinal neoplasms undergoing computed tomography before surgical exploration were entered in a prospective study to assess the value of computed tomography in the preoperative staging of anterior mediastinal tumours. Correct prediction of location, size, and tissue density was obtained in all 60 cases. Correct identification of the nature of the tumours was achieved by computed tomography in 37 of the 54 previously undiagnosed cases. Particular attention was given to the evaluation of the relation of the tumour to adjacent mediastinal structures, to predict the feasibility of radical surgical procedures. Overall sensitivity, specificity, and accuracy in identifying resectability were 46%, 85%, and 64%, with positive and negative predictive indices of 78% and 58%. Capsulated or highly invasive lesions were clearly distinguished, and the presence or absence of infiltration of mediastinal vessels, pericardium, and chest wall was correctly recognised in most cases. It is suggested that the evaluation of anterior mediastinal neoplasms should include computed tomography because of its accuracy in predicting size, location, and tissue density of the neoplasm. Computed tomography may suggest, often with good reliability, the histological type of the tumour and its relation to contiguous mediastinal structures, thus contributing to the choice of the appropriate surgical approach or route for biopsy.
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Affiliation(s)
- E A Rendina
- Department of Thoracic Surgery, Università La Sapienza, Rome, Italy
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32
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Colomer bosch R, Casas curto J, Alvarez moro F, Escalada berta J, Tapies barba C. Manifestaciones radiologicas de los tumores germinales malignos primitivos de mediastino. Arch Bronconeumol 1987. [DOI: 10.1016/s0300-2896(15)31981-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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33
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Abstract
This review details pertinent anatomical, radiological, pathological, and clinical information regarding primary anterior mediastinal tumors. Although the majority of these lesions are included in one of several subgroups, for example, thymic tumors, teratomas, or thyroid abnormalities, other less common entities will occasionally be encountered by the practicing surgeon. Likewise, there are variations in the frequency distribution of anterior mediastinal lesions in children as opposed to adults. Management of these individual lesions is outlined.
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34
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Feigin DS, Padua EM. Mediastinal masses: a system for diagnosis based on computed tomography. THE JOURNAL OF COMPUTED TOMOGRAPHY 1986; 10:11-21. [PMID: 3943350 DOI: 10.1016/0149-936x(86)90003-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A revised system for mediastinal mass differentiation has been developed and used at the Veterans Administration Medical Center, San Diego, and University Hospital of the University of California, San Diego. Contrast medium infusion or bolus computed tomography of the entire mediastinum is obtained, except when the mass is probably a thyroid mass (123I scan then obtained first) or an esophageal mass (barium swallow evaluation then obtained first). Next computed tomography density is determined, and only subsequently are masses of similar density subdivided by location. Further differentiation is based on computed tomography imaging parameters. A new algorithm for evaluation of mediastinal masses has resulted from use of this system. The system has been shown to increase specificity of differential diagnosis and to result in increased efficiency of evaluation of patients with mediastinal masses.
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35
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Nakata H, Nakayama C, Nobe T, Koga M. Computed tomography characterization of anterior mediastinal tumors. THE JOURNAL OF COMPUTED TOMOGRAPHY 1985; 9:161-6. [PMID: 3987337 DOI: 10.1016/0149-936x(85)90014-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The computed tomography manifestations of 39 patients with histologically proved anterior mediastinal tumors were studied by categorizing the tumors by content as solid homogeneous, cystic homogeneous, and heterogeneous. Among 24 solid tumors, thymomas were easily distinguished by their lack of invasiveness from malignant lymphomas and germ-cell tumors. Among 11 cystic tumors, pericardial and thymic cysts were differentiated from cystic teratomas and bronchogenic cysts by their lack of recognizable capsules with or without calcification. The differential diagnosis of a variety of tumors of the anterior mediastinum was facilitated by computed tomography in all but a few exceptional cases.
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