Diagnostic evaluation of mediastinal lesions: Analysis of 144 cases

Abstract

Background:Mediastinum is a “Pandora's box” with many neoplastic and nonneoplastic lesions. The purpose of this study was to analyze our institutional experience of mediastinal lesions on fine-needle aspiration cytology (FNAC) and/or biopsy.Materials and Methods:This study was an analysis of 144 patients who had undergone ultrasound-guided FNAC and/or core biopsy for mediastinal lesions.Results:A total of 144 cases of suspected mediastinal masses were seen, and in 139 cases, tissue diagnosis was attempted. Out of 139 cases, 93 cases were neoplastic in nature (67%), 32 were nonneoplastic (23%), and 14 remained inconclusive (10%). Among neoplastic mediastinal lesions, metastatic carcinoma (37.4%) was the most common neoplastic lesion, followed by non-Hodgkin's lymphoma (12.2%), Hodgkin's lymphoma (7.1%), thymic lesions (3.5%), etc. Among nonneoplastic conditions, tuberculosis was the most common lesion (20.1%). An accurate tissue diagnosis was made in 89.9% cases by FNAC or core biopsy of mediastinal lesions in this study. Procedure-related mortality was nil. Complications were mostly minor and included chest pain in 24.5%, small pneumothorax in 13.6% requiring closed tube thoracostomy in 1.4%, and scanty hemoptysis in 9.3% cases.Conclusion:Neoplastic mediastinal lesions are more common than nonneoplastic lesions, with metastatic carcinoma being the most common cause followed by tuberculosis. A wide variety of lesions observed in this study stress on the importance of cytohistological diagnosis in all cases of mediastinal lesions for the final diagnosis and management planning. A guided FNAC or core biopsy is still accurate, well tolerated, and devoid of major complications.

Histopathological Spectrum of Mediastinal Lesions in a Tertiary Care Centre, Andhra Pradesh, India

“…In the adult age group 18(41.8%) were benign lesions and 21 (48.84%) were malignant lesions out of which three cases were of suspicious of malignancy where definitive diagnosis could not be established. This correlated with the present study and studies from Rajasthan by Dexit R, Shah N Set al 1 Thymic cysts are both congenital and acquired, congenital cysts are derived from remnants of the thymo-pharyngeal duct typically unilocular and contain clear fluid whereas acquired cysts are more common and multilocular arise in association thymomas, lymphomas and germ cell tumours, our case is unilocular in child aged 4 yrs. We encountered also a case of thymic lipoma and thymic hyperplasia each ( Fig.…”

“…In the present study of 43 cases of mediastinal lesions analysed malignant lesions were more frequent 21(48.84%) than benign lesions 18 (41.8%), which is comparable to many other studies 1,7 . Primary thymic neoplasms, and lymphomas are the most common tumours in mediastinum, nearly 50% of all mediastinal masses were anterior mediastinal tumours, which included thymic cysts, thymomas, a case of thymic lipoma, teratoma, thymic hyperplasia, colloid goiter thyroid each and lymphomas 5 .…”

“…Age distribution of all these cases was between 04 -70 yrs. [1][2][3][4][5][6][7][8][9][10][11][12] Out of total 43 cases we encountered 39 cases (90.60 %) were in adult age group (>16 yrs.) and the mean age in adults was (47.7 yrs.).…”

“…15 Thymomas were more common benign primary neoplastic lesions encountered in adult age group which are rare and were not seen in paediatric age group in the present study. 1,4 Thymic carcinomas in general account for 20% of thymic epithelial tumours with mean age of 50 yrs., in our study mean age was 52 yrs.…”

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“…La utilidad diagnóstica de la biopsia por aspiración con aguja fina en lesiones de tórax, sobre todo las de pulmón y mediastino, radica en la obtención de material adecuado que permita establecer diagnósticos sin tener que exponer a los pacientes a estudios más invasivos. 4 Cuando la selección de los pacientes es óptima, con una integración de un equipo de trabajo conformado por radiólogos, neumólogos y patólogos pueden emitirse diagnósticos asertivos, rápidos y de bajo costo.…”