Clinicopathological profile of primary mediastinal masses-Our experience
The mediastinum starts from thoracic inlet superiorly and up to the diaphragm inferiorly, bounded laterally by both the pleura. It’s further divided into anterior, middle and posterior mediastinum to categorize the tumor and diseases of mediastinum according to their site and location. A variety of tumor and cysts occur in the mediastinum and affect people of all ages. Primary mediastinal tumors are rare representing 3% of all tumors within the chest with an average incidence of 8 cases seen per year2-4. Neoplastic masses can be both benign and malignant in nature and can be primary or secondary in origin. The tissue of origin can be thymic, hematopoietic, lymphatic, germinal, neurogenic or mesenchyme. Patients may be asymptomatic altogether and the lesion may be discovered incidentally on routine chest radiographs obtained for other reasons. They may present with vague chest complaints and or signs and symptoms due to compression and invasion of mediastinal structures.
Mediastinal masses are rare and can present as a challenge for clinicians due to protean manifestations. Clinicians need to be vigilant as a lot of times diagnosis can be delayed and patients can land up with features of respiratory distress due to compression of trachea or carina as seen with some of our cases. Anterior mediastinal masses are most common followed by posterior mediastinum which mostly comprises of neurogenic tumors. Middle mediastinal masses are very rare and are generally benign cysts. Surgical resection of the mass is required in most of the cases. Most of the time diagnostic clues can be picked up on routine Chest X-ray. CECT scan reveals the exact extent of the mass and USG or CT guided FNAC can help in making the tissue diagnosis. Other investigations are usually adjuvant and should only be done when other investigations fail or when extra information is required based upon above investigations. Though excision by thoracotomy is the operative management chosen for most of the cases, use of VATS should be done whenever feasible as it leads to less postoperative pain ,faster recovery, short hospital stay, better cosmetic results and overall patient satisfaction rate.
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