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Pediatrics > Mediastinal masses > Flashcards

Mediastinal masses Flashcards

1
Q

Extragonadal germ cell tumor

A

Klinefelter 47 XXY

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2
Q

Pneumoperitoneum/raising thymus

A

Spinager sail sign

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3
Q

Lymphoma vs thymic rebound

A

Lymphoma (>10 year old)

Thymic rebound (<10 year old): Glucocor, Chemo

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4
Q

Hodking vs Non-Hodking lymphoma

A

Hodking lymphoma is 10 times more common and involves thymus often

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5
Q

Germ cell tumor

A

Teratoma: Cyst + fat + calcium
Seminoma: Bulky and lobulated
NSGCT: Hemorrhage and necrosis

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6
Q

Pulmonary coccidiodomycosis

A

Southwest, consolidation

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7
Q

Histoplasmosis

A

Midwest and Southeast

Histoplasmoma: target lesions (pathognomonic)

MOstly asymptomatic infections

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8
Q

Primary TB

A

Mexico

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9
Q

Mononucleosis

A

Spleen

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10
Q

Duplication cyst

A
  1. Bronchogenic: Mediastinal, MOST common.
  2. Enteric: Adjacnet to esphagus
  3. Neuroenteric: Abnormal spine
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11
Q

Posterior mediastinal mass

A

< 10 year old: Neuroblastoma

> 10 year old: Ganglioneuroma or Ganglioneuroblastoma

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12
Q

Lung metastasis < 10 years

A

Neuroblastoma, however Wilms most often mets to here.

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13
Q

Askin tumor

A

BFM + rib involvement

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14
Q

Pleuropulmonary blastoma

A

BFM WITOUT rib involvement

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15
Q

Extramedullary hematopoiesis

A

Coarse vertebra and homogeneous soft tissue mass

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16
Q

Thymic rebound hyperplasia

A

Stress, atrophy>normal or hypertrophy.

May take 9 months to go back to its original size

17
Q

Mediastinal lymphoma

A

60% Hodking
40% NonHodking

  1. Sclertoic Hodking
  2. Diffuse large B cell
  3. Lymphoblastic

Lymphoma arises from the thymus or anterior mediastinal lymph nodes

Best prognosis: Hodking lymphoma

Ga 67 used to assess viability of tumor

18
Q

Hodking lymphoma

A 
Curable 90% of the times
B symptoms (night sweats and weight loss)
Bimodal peak (youngester and oldest)
 Reed-Sternberg cells (considered to be a type of B cell). 
EBV infection is present in 40-80% depending on subtype 4.

Classical: Positive for CD15/CD30 (nodular sclerosing)

Non-classical: Positive for CD 19, 20, 22 (nodular paragranuloma)

Systematic nodal spread pattern making accurate staging important.

Nodular lymphocyte-predominant: best prognosis
Lymphocyte depleted: worse prognosis

Stage IIa and below: Localized radiotherapy
Stage IIb and above: Chemotherapy +/- radiotherapy to sites of large tumor bulk

19
Q

Stage Hodking lymphoma

A

Stage IIa and below: Localized radiotherapy
Stage IIb and above: Chemotherapy +/- radiotherapy to sites of large tumor bulk

STAGES:

Limited

  • Stage I: one node or group of adjacent nodes
  • Stage IE: single extra-lymphatic site in the absence of nodal involvement
  • Stage II: two or more nodal groups, same side of diaphragm
  • Stage IIE: contiguous extra-lymphatic extension from a nodal site with or without involvement of other lymph node regions on the same side of the diaphragm.

Advanced

  • Stage III: nodes on both sides of the diaphragm; nodes above the diaphragm with spleen involvement
  • Stage III(1): involvement of the spleen or splenic, hilar, celiac, or portal nodes
  • Stage III(2): involvement of the para-aortic, iliac, inguinal, or mesenteric nodes
  • Stage IV: diffuse or disseminated involvement of one or more extranodal organs or tissue beyond that designated E, with or without associated lymph node involvement

All cases to indicate the absence (A) or presence (B) of systemic symptoms (fever/night sweats/unexplained weight loss)

  • Designation of (E) refers to extranodal contiguous extension that can still be encompassed within a irradiation field appropriate for nodal disease of the same anatomic extent (if more extensive than that, label as IV)
  • Designation of (bulky) if a single nodal mass >10 cm or >1/3 of transthoracic diameter
20
Q

Non Hodking

A

mature B-cell lymphoma
mature T-cell and NK-cell lymphoma

85%) of lymphomas are B-cell with the remainder (15%) being T-cell

21
Q

Primary mediastinal large B cell lymphoma

A
22
Q

Thymoma (OLD PEOPLE)

A

Most common primary neoplasm of the anterosuperior mediastinum

Associations: Myastenia gravis, pure red cell aplasia, hypogammaglobulinemia, autoimmune diseases (SLE).

type A: tumors (medullary histology thymomas), are typically rounded, smooth or somewhat lobulated masses of soft tissue attenuation

type B: tumors more frequently demonstrate calcification, although calcification is also frequently seen in thymic carcinoma

type C:
tumors (thymic carcinoma) usually demonstrate an invasion of mediastinal fat or mediastinal structures and are usually much larger than type A or B tumors

23
Q

Anterior mediastinal germ cell tumors

A
  1. Teratoma (bening, most common cause)
    2 Seminomatous germ cell tumor
  2. NSGCT
  3. Others (malignant)
24
Q

Mediastinal teratoma

A

60% of all mediastinal germ cell tumors

Production of b-hcg or insulin

Mature teratomas have been associated with:
- Klinefelter syndrome (47, XXY)

Immature teratomas (management depends on alpha-FP levels. If these are elevated then postoperative chemotherapy is usually employed) can be associated with:

  • non-lymphocytic leukemia
  • pleomorphic undifferentiated sarcoma
25
Q

Mediastinal seminoma

A

β-hCG and/or LDH might be elevated

AFP is usually normal.

26
Q

Thoracic neuroblastoma

A

Pediatrics (10 decks)

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