Comparison of Benign and Malignant Mediastinal Masses in Children-Clinical Features, Etiology and Treatment Outcome: a Prospective Observational Study

Abstract

Introduction: Mediastinal masses in children pose a diagnostic as well as therapeutic dilemma to clinicians. There is paucity of information in existing literature regarding relative prevalence of various etiologies and their management outcomes in children. Methods:In this single institution observational prospective studycarried out between August 2013 and July 2017, 86 children with mediastinal masses were evaluated for the etiology, clinical features and treatment outcomes. Prevalence of superior mediastinal syndrome (SMS), factors associated with its occurrence and its clinical implications were also determined.Results: Out of 86 children with mediastinal masses, 28 (32%) had benign masses and 58 (68%) had malignant masses. Tuberculosis (TB) was the commonest among benign mediastinal mass seen in 22 (79%) children. Among the common malignant masses, Hodgkin's lymphoma was seen in 16 (27%), T cell acute lymphoblastic leukemiawas seen in 14 (24%) and neurogenic tumors were seen in 8 (13%) children. SMS was present in 40 (45%) children. SMS was present in 8 (24%) patients with T cell acute leukemia (p=0.01). Solid tumors in advanced stage i.e. stage III and IV were more likely to have SMS (odds ratio 2.7, p=0.29). The overall progression free survival was 76% and 97% for malignant and benign mediastinal masses respectively at the end of median follow up period of 24 months (p=0.01). The subgroup with superior mediastinal syndrome had relatively acute presentation and poor final outcome. Conclusion:In children, malignant mediastinal masses are more common than benign mediastinal masses and they have relatively poor prognosis. Hodgkin's lymphoma and TB are the most common cause of malignant and benign mediastinal masses in children respectively. T cell leukemia is the most common cause of SMS. The prognosis was comparatively dismal for the subgroup with SMS.