Mediastinal Masses In Children: Experience With 120 Cases

Abstract

Primary mediastinal malignancies are rare tumors and can originate from any mediastinal organ or tissue such as thymic, neurogenic, lymphatic, germinal, or mesenchymal. The authors reviewed all cases of primary pediatric mediastinal masses diagnosed over a 25-year period to determine the pattern of presentation, the histology, and the outcome of the surgical treatment. In this study, 120 primary pediatric mediastinal mass cases diagnosed between 1985 and 2011 are retrospectively evaluated according to their age, sex, symptoms, anatomical location, surgical treatment, and histopathological evaluation. The median age of the patients was 5.8 years. There were 34 benign and 86 malign tumors. Thirty patients were asymptomatic. Common symptoms in the patients were cough, dyspnea, fatigue, fever, abdomen pain, back pain, and neurological symptoms. According to their origins, they were presented as neurogenic tumors (38.3%), lymphomas (18.3%), undifferentiated sarcomas (15%), germ cell tumors (7.5%), and the other tumors (22%) thymic pathologies, lymphangiomas, rhabdomyosarcomas, lipomas, hemangiomas, and Wilms' tumor. Complete resection of the tumor was performed in 86 patients, partial resection of the tumor was the intervention in 11 patients. In 23 patients, biopsy was undertaken. Because of the high incidence of asymptomatic or nonspecific presentation such as the upper airway disease, the presentation of a mediastinal mass in children may be challenging. Neurogenic tumors or lymphomas are indicating surgery, if possible complete resection, for both benign and malignant conditions. Although surgery is the mainstay of therapy for most mediastinal tumors, an experienced multidisciplinary approach is necessary.

Mediastinal lesions across the age spectrum: a clinicopathological comparison between pediatric and adult patients

“…The frequency of lymphomas among our total series 10%, was comparable to that of Japan 12.3% ( p = 0.24), but significantly lower than that of Davis et al, 16% ( p = 0.01) [ 7 ], and of Whooley et al, 19%, ( p = 0.01) [ 12 ]. Concerned with our pediatric category, lymphoma was within the range of previous reports [ 26 ], Japan 13% ( p = 0.39) [ 6 ], USA 17.3% ( p = 0.16) [ 12 ], and Turkey 18.3% ( p = 0.73) [ 27 ], however, it was significantly lower than USA reports; 32.3% ( p = 0.01) [ 3 ] and 55% ( p < 0.01) [ 9 ], as well as that of Simpson et al, 49.6% ( p < 0.01) [ 15 ]. Likewise, the prevalence of lymphomas in our adult subset 7%, was significantly lower than that of USA reports 21% and 55%, both ( p < 0.01) [ 5 , 9 ].…”

Distinguishing Benign Mediastinal Masses from Malignancy in a Histoplasmosis-Endemic Region

“…[2-9] Distinguishing between benign and malignant mediastinal masses is challenging for practitioners in areas endemic for histoplasmosis, where up to half of cases are attributable to this infection. [6, 7]…”

Vitamin K Deficiency Presenting in an Infant with an Anterior Mediastinal Mass: A Case Report and Review of the Literature

“…Anterior mediastinal masses in neonates and infants could represent venous or lymphatic malformations and thymic enlargement (whether due to thymic hyperplasia, thymic cysts, thymoma, or thymic hemorrhage). Rarer possibilities include germ cell tumors (primarily teratomas), neuroblastoma, rhabdomyosarcoma, lymphoma, Langerhans cell histiocytosis, or Wilm's tumor [ 18 ]. However, coagulopathy as an additional clinical feature narrows the spectrum of possibilities to primarily venous/lymphatic malformations and (less likely) lymphomas [ 19 – 21 ].…”