Medical Archive

Introduction

Mediastinal Masses

• Anterior
  • “4Ts”: thymoma, teratoma, thyroid neoplasm, and terrible lymphoma
  • Thymoma
    • ½; MG??, anemia ? -> resection + RTx
  • Lymphoma
    • Age 15-35 & >60
  • Mixed germ cell tumor (nonseminoma)
    • Age 20-40
    • Presence of fat or calcium
    • Elevated ß-hCG, aFP
• Middle
  • Vascular mass
  • LN enlargement
  • Bronchogenic cyst
• Posterior
  • Neurogenic tumor
  • Esophageal leiomyoma

Diagnostic strategies

• ??? indolent, but lymphoma, germ cell tumor? ???
• Blood test : ?hCG, AFB
• Pathologic Dx
• ?? ?? ? ??? Surgical Bx > FNA, CNB
• Surgical Bx
• Parasternal ant. Mediastinotomy, Mediastinoscopy, VATS, open procedure

Thymoma & Thymic carcinoma

?? ?? ??. MG??. 40-70?
Carcinoma? MG? ?? X
Classification? WHO(cell ??)? ???? ?? ??
Complete resection! Partial? palliative ??. CTx, RTx? X ?? ??? ??? ??.

Germ cell tumors of mediastinum

P4 S1 C84 <Testicular Cancer>

Mature teratoma
• m/c. CT? ??? ??, AFP, ?hCG ??, ? ?? ?? ??
• Bx ?? surgical excision! RTx, CTx? ???, ?? ?? ?
Seminomatous germ cell tumor
• ????, ?? ??? ?? ??. FNA, CNB? ??, AFP, ?hCG ??
• RTx + Cisplatin based CTx. Meta? ??.
Non-seminomatous germ cell tumor
• ????, ????. FNA, CNB? ??, AFP ?, ?hCG ??
• Cisplatin based CTx. ???? surgery
• Seminomatous?? meta ? survival ?

Neurogenic tumors of mediastinum

• Malig? ? ??? ???? ??
• Nerve sheath, autonomic ganglia, paraganglionic tissue ?? origin
• ?? Bx?? ?? ???. ?? ? ??? ???!

Acute Mediastinitis

??: ???? (post op., ?? ?? ?-Boerhaave’s SD)
??: Chest pain, dyspnea, pneumo-mediastinum
??: needle aspiration, CT, ????? (perforation? ??)
??: ?? ???, surgical drainage, esophageal repair

Chronic mediastinitis

Pneumomediastinum

Hamman’s sign: ???? ?? ??? crunching noise
?? ?? ??! ??? ?? ??? ?? ???.