Clinicopathological Spectrum of Mediastinal Mass Lesions - A Cross-Sectional Study of 58 Cases in Kolkata, West Bengal

2021 ◽  
Vol 8 (25) ◽  
pp. 2180-2186
Author(s):  
Debarati Pathak ◽  
Abhijit Banerjee ◽  
Soma Ghosh ◽  
Arghya Bandyopadhyay ◽  
Tushar Kanti Das
Keyword(s):  
Germ Cell ◽  
Superior Vena ◽  
Vena Cava ◽  
Histopathological Study ◽  
Anatomical Location ◽  
Germ Cell Tumours ◽  
Surgical Biopsy ◽  
Ct Guided ◽  
Mediastinal Masses ◽  
Neoplastic Lesions

BACKGROUND Mediastinal masses, an enigma to surgical pathologist are among the most complicated lesions explored and relatively inaccessible. They often connote a process with mass effect presenting with superior mediastinal syndrome. This is a challenging area faced by surgical pathologist as varied lesions are found here and often biopsies obtained are tiny and crushed. Appropriate therapy of various mediastinal tumours differs considerably and may significantly impact survival. We wanted to evaluate the various lesions in different compartments of mediastinum and categorise them according to anatomical location, and histopathology. METHODS Patients with mediastinal masses attending outpatient department were selected, history taken and relevant investigations done with radiological evaluation for proper anatomical location of lesion. Histopathological study done on tissues obtained by ultrasound / CT guided biopsy, open surgical biopsy were categorized according to histologic types. Immunohistochemistry was done wherever applicable. RESULTS A total of 58 cases of mediastinal lesions were studied where males predominated and age of patients ranged from 11 months to 68 yrs. All patients were symptomatic. Shortness of breath, superior vena cava syndrome was dominant in anterior and superior mediastinal lesions, middle and posterior mediastinal masses presented with chest pain. Most lesions were neoplastic. Germ cell tumours were found in (24.14 %) followed by lymphoma in (20.69 %) and thymic lesions in (18.97 %) of patients. Neurogenic tumours found in (13.79 %) were located in posterior mediastinum whereas, germ cell tumours and lymphomas were located in anterior mediastinum. Non neoplastic lesions included tuberculosis, sarcoidosis. Unsuspected lesion was metastatic deposit of adenoid cystic carcinoma. CONCLUSIONS A wide variety of non-neoplastic and neoplastic lesions can be found in different compartments of mediastinum and accurate diagnosis is considered necessary to formulate management strategies. KEYWORDS Mediastinum, Biopsy, Radiology, Histopathology

Surgical resection of large anterior mediastinal masses: Results of median sternotomy approach.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20005-e20005
Author(s):  
Raj Mohan
Keyword(s):  
Superior Vena ◽  
Germ Cell Tumors ◽  
Median Sternotomy ◽  
Vena Cava ◽  
Postoperative Mortality ◽  
Surgical Approaches ◽  
Femoral Access ◽  
Ct Guided ◽  
Mediastinal Masses ◽  
Cardiac Bypass

e20005 Background: Anterior mediastinal masses are a diverse group of tumors generally presenting as compressive symptoms. Larger masses require open surgical approaches including median sternotomy or sterno-thoracotomy. In this study we analyzed the surgical and pathological outcomes of large anterior mediastinal masses resected through sternotomy approach. Methods: Data of 16 patients with anterior mediastinal masses ( > 10 cms) treated surgically was analyzed retrospectively. All the patients were evaluated preoperatively with MRI, CT guided biopsy and pulmonary function test followed by exploration through median sternotomy approach with/without cardiac bypass (through femoral access). Adjuvant chemo-radiation was used according to histopathological features. Results: A total of 10 male and 6 females with median age 42 years (range: 6-62) underwent resection. Three patients received neoadjuvant chemotherapy and the mean tumor size was 12.2 cms. Histopathologies included mature teratomas/dermoids (4), thymic carcinoma (3), nerve sheath tumors (3), malignant germ cell tumors (3), synovial sarcoma (1) primary mediastinal goiter (1) and inflammatory pseudo tumor (1). There was no postoperative mortality and two patients required cardiac bypass. Bovine pericardium was used in two patients for the loss of large are of pericardium. One patient required biograft for replacement of resected superior vena cava. Major morbidities included prolonged ventilation and intrathoracic collection in two patients. All the patients were disease free after a median follow up of 14 months. Conclusions: Large anterior mediastinal masses are challenging surgically. An aggressive surgical approach through median sternotomy in association with cardiac bypass helps in complete resection and may lead to optimal results.

scholarly journals Seminomatous Extragonadal Germ Cell Tumor with Complete Obstruction of the Superior Vena Cava Responding to Intensive Chemotherapy

2011 ◽  
Vol 6 (1) ◽  
pp. 32-34
Author(s):  
Yoshinobu Moritoki ◽  
Toshiki Kato ◽  
Hidenori Nishio ◽  
Hideyuki Kamisawa ◽  
Yasuhiko Hirose ◽  
...  
Keyword(s):  
Germ Cell ◽  
Superior Vena Cava ◽  
Germ Cell Tumor ◽  
Superior Vena ◽  
Vena Cava ◽  
Cell Tumor ◽  
Intensive Chemotherapy ◽  
Complete Obstruction ◽  
Extragonadal Germ Cell Tumor

Pineal tumours

2019 ◽  
pp. 427-438
Author(s):  
Mueez Waqar ◽  
Samantha Mills ◽  
Conor L Mallucci ◽  
Michael D Jenkinson
Keyword(s):  
Germ Cell ◽  
Adjuvant Radiotherapy ◽  
Residual Disease ◽  
Germ Cell Tumour ◽  
Third Ventriculostomy ◽  
Germ Cell Tumours ◽  
Line Treatment ◽  
Surgical Biopsy ◽  
First Line Treatment

Tumours of the pineal are very rare, tend to be more common in children and while there are a wide variety of pathologies the majority are germ cell tumours and pineal parenchymal tumours. These tumours usually present with hydrocephalus and endoscopic third ventriculostomy is the operation of choice. It is important to test for tumour markers in the blood and cerebrospinal fluid, since the diagnosis of a secreting germ cell tumour precludes the need for surgery. Surgical biopsy can be performed by endoscopy or with frame-based stereotaxy. For germ cell tumours chemotherapy and radiotherapy are the mainstay of treatment, but surgery has a role in the management of residual disease. For primary parenchymal tumours, maximum surgical resection is the first-line treatment and can be curative for pineocytoma. Pineoblastoma require adjuvant radiotherapy and for intermediate grade pineal tumours the role of radiotherapy is still being evaluated.

scholarly journals Non-Seminomatous Germ Cell Tumor Presenting with Superior Vena Cava Syndrome

2017 ◽  
Vol 18 ◽  
pp. 902-907 ◽  
Author(s):  
Paolo K. Soriano ◽  
Muhammad F. Iqbal ◽  
Omar M. Siddiqui ◽  
Jeff F. Wang ◽  
Meghna R. Desai
Keyword(s):  
Germ Cell ◽  
Superior Vena Cava ◽  
Germ Cell Tumor ◽  
Superior Vena Cava Syndrome ◽  
Superior Vena ◽  
Vena Cava ◽  
Cell Tumor ◽  
Vena Cava Syndrome

Utility of transesophageal echocardiography in the assessment of mediastinal masses and superior vena cava obstruction

1991 ◽  
Vol 122 (5) ◽  
pp. 1469-1472 ◽  
Author(s):  
Phillip R. Dawkins ◽  
Marcus F. Stoddard ◽  
Norman E. Liddell ◽  
Rita Longaker ◽  
David Keedy ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Superior Vena Cava Obstruction ◽  
Mediastinal Masses

scholarly journals Sequential Treatment of Superior Vena Cava Syndrome Caused by of Non-small Cell Carcinoma Lung Cancer (NSCLC) with Vascular Stenting and Iodine-125 Implantation

2009 ◽  
Vol 8 (4) ◽  
pp. 281-287 ◽  
Author(s):  
Lianxiang Xiao ◽  
Zhenjia Li ◽  
Lebin Wu ◽  
Zengtao Sun ◽  
Xianghong Yu
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena Cava Syndrome ◽  
Superior Vena ◽  
Symptom Relief ◽  
Vena Cava ◽  
Sequential Treatment ◽  
Endovascular Stenting ◽  
Ct Guided ◽  
Vena Cava Syndrome ◽  
Iodine 125

Feasibility and efficacy of sequentially performed endovascular stenting and Iodine-125 brachytherapy for malignant superior vena cava syndrome (SVCS) were evaluated. Thirty-four patients with malignant SVCS caused by NSCLC underwent sequential treatment of endovascular stenting and Iodine-125 brachytherapy. SVCS was diagnosed in all patients by CT images or vena-cavography. Pathology diagnosis was acquired by image guided biopsy. Endovascular stent placement was performed as first-line treatment for symptom relief. CT-guided Iodine-125 seed implantation performed 24hr after stenting. Clinical end points were resolution of symptoms and local efficacy of primary malignancy regression. Symptom relief rate was >90% after 24hr and 97% after 3 months. No migration of seeds or restenosis occurred in any patient. The local efficacy (defined as either partial or complete response) was 53%, 79%, 88% and 74% after 1, 3, 6 and 12months, respectively. Mean SVCS-free survival time was 305 days (range 120–960 days). Two patients were still alive at the time of this writing, Thirty-one died from progression and one died from acute heart disease. Sequentially performed endovascular stenting and Iodine-125 brachytherapy provides a safe and effective alternative for malignant SVCS caused by NSCLC.

scholarly journals Superior Vena Cava Syndrome: A Presenting Feature of Mediastinal Germ Cell Tumor

2010 ◽  
Vol 25 (2) ◽  
pp. 131-133 ◽  
Author(s):  
Mahua Roy ◽  
Rajat Bandyopadhyay ◽  
Narayan Pandit ◽  
Soumita Sengupta
Keyword(s):  
Germ Cell ◽  
Superior Vena Cava ◽  
Germ Cell Tumor ◽  
Superior Vena Cava Syndrome ◽  
Superior Vena ◽  
Vena Cava ◽  
Cell Tumor ◽  
Mediastinal Germ Cell Tumor ◽  
Vena Cava Syndrome
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