TY  - CHAP
M1  - Book, Section
TI  - Mediastinal Disease
A1  - Plantmason, Lee
A1  - Lui, Natalie
A1  - Theodore, Pierre
A2  - Yuh, David D.
A2  - Vricella, Luca A.
A2  - Yang, Stephen C.
A2  - Doty, John R.
PY  - 2014
T2  - Johns Hopkins Textbook of Cardiothoracic Surgery
AB  - EpidemiologyThymic  tumors  are  the  most  common  primary  neoplasm  of  the  anterior  mediastinum,  accounting  for  about  20  percent  of  anterior  mediastinal  masses.  Their  peak  incidence  is  in  middle-aged  adults  between  the  ages  of  30  and  50  years.  Although  lymphomas  are  the  most  common  neoplasm  of  the  mediastinum,  primary  mediastinal  lymphomas  are  rare  and  account  for  less  than  10  percent  of  lymphomas.  Mediastinal  germ  cell  tumors,  including  both  seminomas  and  nonseminomas,  account  for  about  20  percent  of  anterior  mediastinal  masses  and,  with  the  exception  of  teratomas,  occur  almost  exclusively  in  males.  All  of  these  tumors  have  a  peak  incidence  in  young  adults  in  their  third  decade  of  life.  In  general,  extragonadal  germ  cell  tumors  are  rarely  primary  tumors,  with  the  mediastinum  frequently  being  a  site  of  metastasis.PathophysiologyPathophysiologic  processes  range  from  the  antibody-mediated  effects  of  myasthenia  gravis  (MG)  seen  with  thymoma  to  the  mass  effects  of  tumors  as  noted  in  superior  vena  cava  (SVC)  syndrome.  The  primary  mediastinal  lymphomas  include  Hodgkin,  non-Hodgkin,  and  lymphoblastic  lymphomas.  Seminomas,  which  occur  exclusively  in  men,  are  generally  malignant  but  highly  responsive  to  treatment,  whereas  nonseminomas  can  range  from  benign  teratomas  that  have  a  very  low  percentage  of  malignant  transformation  (8  cm)  often  receive  neoadjuvant  chemotherapy,  and  patients  with  Masaoka  Stage  III  or  IV  often  receive  comprehensive  treatment  with  chemotherapy,  radiotherapy,  and  surgery.  Treatment  of  MG  includes  immunosuppression  with  prednisolone,  cyclosporine,  and  azathioprine;  rituximab  and  cyclophosphamide  for  severely  drug-resistant  patients;  cholinesterase  inhibitors  such  as  pyridostigmine;  plasma  exchange;  and  thymectomy.  Treatment  of  lymphomas  includes  chemotherapy,  radiotherapy,  and  immune  modulators  such  as  rituximab.  Treatment  of  teratomas  is  surgical  resection.  Treatment  of  seminomas  is  cisplatin-based  chemotherapy.  For  patients  suffering  from  relapse,  high-dose  chemotherapy  with  autologous  stem  cell  transplantation  is  suggested.  In  general,  surgical  resection  is  not  performed  for  relapse  due  to  the  excessive  morbidity  from  the  desmoplastic  reaction  induced  by  chemotherapy.  Treatment  of  nonseminomas  includes  chemotherapy  and  surgical  excision  for  residual  disease,  given  the  poor  results  noted  with  salvage  chemotherapy.Outcomes/PrognosisMost  patients  with  thymoma  can  expect  a  favorable  outcome,  while  patients  with  concomitant  MG  can  expect  a  normal  life  expectancy  ...
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1104586761
ER  -