Mediastinal masses Flashcards
Extragonadal germ cell tumor
Klinefelter 47 XXY
Pneumoperitoneum/raising thymus
Spinager sail sign
Lymphoma vs thymic rebound
Lymphoma (>10 year old)
Thymic rebound (<10 year old): Glucocor, Chemo
Hodking vs Non-Hodking lymphoma
Hodking lymphoma is 10 times more common and involves thymus often
Germ cell tumor
Teratoma: Cyst + fat + calcium
Seminoma: Bulky and lobulated
NSGCT: Hemorrhage and necrosis
Pulmonary coccidiodomycosis
Southwest, consolidation
Histoplasmosis
Midwest and Southeast
Histoplasmoma: target lesions (pathognomonic)
MOstly asymptomatic infections
Primary TB
Mexico
Mononucleosis
Spleen
Duplication cyst
- Bronchogenic: Mediastinal, MOST common.
- Enteric: Adjacnet to esphagus
- Neuroenteric: Abnormal spine
Posterior mediastinal mass
< 10 year old: Neuroblastoma
> 10 year old: Ganglioneuroma or Ganglioneuroblastoma
Lung metastasis < 10 years
Neuroblastoma, however Wilms most often mets to here.
Askin tumor
BFM + rib involvement
Pleuropulmonary blastoma
BFM WITOUT rib involvement
Extramedullary hematopoiesis
Coarse vertebra and homogeneous soft tissue mass
Thymic rebound hyperplasia
Stress, atrophy>normal or hypertrophy.
May take 9 months to go back to its original size
Mediastinal lymphoma
60% Hodking
40% NonHodking
- Sclertoic Hodking
- Diffuse large B cell
- Lymphoblastic
Lymphoma arises from the thymus or anterior mediastinal lymph nodes
Best prognosis: Hodking lymphoma
Ga 67 used to assess viability of tumor
Hodking lymphoma
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
Stage Hodking lymphoma
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
Non Hodking
mature B-cell lymphoma
mature T-cell and NK-cell lymphoma
85%) of lymphomas are B-cell with the remainder (15%) being T-cell
Primary mediastinal large B cell lymphoma
Thymoma (OLD PEOPLE)
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
Anterior mediastinal germ cell tumors
- Teratoma (bening, most common cause)
2 Seminomatous germ cell tumor - NSGCT
- Others (malignant)
Mediastinal teratoma
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
Mediastinal seminoma
β-hCG and/or LDH might be elevated
AFP is usually normal.
Thoracic neuroblastoma