Malignant and Benign Lesions
• Posterior mediastinum, often superiorly from intercostal or sympathetic nerves
• Nerve sheath tumors (eg, schwannoma and neurofibroma) most common (40-65%)
• Usually benign, 10% malignant
• Malignant tumors arise from nerve cells (neuroblastoma); more common in children
• May be multiple or dumbbell shape
Mediastinal Cystic Lesions
• Arise from pericardium, bronchi, esophagus, or thymus
• 75% located near cardiophrenic angles, 75% on right side
• 10% are diverticula of pericardial sac that communicate with pericardial space
• Bronchogenic cysts arise below carina
• Enterogenous cysts arise along esophagus, may be incorporated, and associated with vertebral anomalies
• 10% nonspecific without identifiable lining
• Common in anterior mediastinum
• Both solid and cystic, may contain teeth or hair
• Ectodermal, endodermal, mesodermal elements present
• Most metastatic from retroperitoneal disease; < 5% are primary tumors
• Seminoma (40%), embryonal carcinomas and nongestational choriocarcinomas (20%), yolk sac (20%), and teratomas (20%) can have both benign and malignant components
• Usually disseminated disease
• Anterior compartment most common but can be anywhere in mediastinum
• Second most common mass in anterior mediastinum
• Mediastinal masses account for < 20% of all thoracic tumors
• Most masses in adults are benign, with recent shift toward more malignant tumors
• Prevalence: Substernal goiter is most common, then neurogenic tumors (26%), cysts (21%), teratodermoids (16%), thymomas (12%), lymphomas (12%)
• 25% of masses are malignant
• Symptoms more common in malignant lesions
• 50% of patients have cough, wheezing, dyspnea, or recurrent pneumonias
• Hemoptysis, chest pain, weight loss, and dysphagia less common, each occurring in 10% of patients
• Myasthenia, fever, superior vena cava (SVC) obstruction, each occurring in 5%
• Cancer suggested if following symptoms are present:
• Fever in Hodgkin disease
• Thymoma: Myasthenia (15-20%), hypogammaglobulinemia, Whipple disease, red blood cell aplasia, Cushing disease
• Hypoglycemia: Rarely in mesothelioma, teratoma, fibroma
• Hypertension and diarrhea in pheochromocytoma and ganglioneuroma
• Neurologic deficits from neurogenic tumors
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