Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

General Thoracic Surgery Notecards > Mediastinal Masses > Flashcards

Mediastinal Masses Flashcards

1
Q

Masses of Anterior/Superior Mediastinal Compartment

A
  • Thymic neoplasm (thymoma, thymic carcinoma, carinoid)
  • Lymphoma
  • Germ cell tumors (teratoma, seminoma, non-seminoma tumor)
  • Thyroid adenoma
  • Parathyroid adenoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Masses of Middle Mediastinal Compartment

A
  • Bronchogenic cyst
  • Pericardial cyst
  • Enteric cyst
  • Lymphoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Masses of Posterior Mediastinal Compartment

A
  • Neurogenic tumors
  • Esophageal/Enteric cyst
  • Lymphoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Clinical presentation of mediastinal masses

A
  • Asymptomatic and incidental (MC)
  • Chest pain
  • Cough
  • Dyspnea
  • Pain and Neurologic deficit (neurogenic tumor)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diagnostic study of choice for mediastinal tumors

A

CT scan

(location, morphology, relationship to other structures)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Diagnostic approach to small (<5cm) tumors with characteristic features (i.e. thymoma, teratoma, benign cyst)

A

Surgical resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Diagnostic approach to large mediastinal tumors

A
  • CT-guided percutaneous biopsy
  • Open biopsy
    • Cervical mediastinoscopy
    • VATS
    • Chamberlain mediastinoscopy
    • Thoracotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Serum tumor markers that much be checked for mediastinal masses (anterior)

A
  • Beta-HCG
  • AFP
  • LDH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Diagnostic algorithm for anterior mediastinal masses

A
  • CXR
  • Chest CT
  • Tissue biopsy (percutaneous vs. open)
  • Serum tumor markers (Beta-HCG, AFP, LDH)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Tumors are most common in what mediastinal compartment

A

Anterior compartment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

95% of all anterior mediastinal compartment tumors include:

A
  • Four “Ts”
    • Thymoma (MC)
    • Teratoma (germ cell tumor)
    • “Terrible” lymphoma
    • Thyroid goiter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

MC anterior mediastinal tumor

A

Thymoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical presentation of thymoma

A
  • M:F (1:1)
  • 30-50 years old
  • 50% = asymptomatic/incidental
  • 50% = symptomatic (pain, dyspnea, cough, horseness)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Thymoma associated syndromes

A
  • Myasthenia gravis
  • Red cell hypoplasia
  • Hypogammaglobulinemia
  • SLE
  • Rheumatoid arthritis
  • UC
  • Thyroiditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

CT characteristics of benign thymoma

A
  • < 5 cm
  • round
  • well-circumscribed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CT characteristics of malignant thymoma

A
  • > 5 cm
  • Irregular shape
  • Invade neighboring structures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment of choice for all thymoma

A
  • Complete excision
    • En bloc resection
      • Pleura
      • Pericardium
      • Innominate vein
      • SVC
      • Lung
    • Can excise one phrenic nerve and dissect tumor off other
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MC surgical exposure/approachs for thymectomy

A

Median sternotomy

Cervical

VATS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Thymoma Staging (5-Yr Survival)

A

Survival based on Stage

  • Stage I (95%)
    • completely encapsulated
  • Stage II (85%)
    • IIa: mediastinal fat/pleura
    • IIb: through capsule
  • Stage III (70%)
    • direct invasion of adjacent organ
  • Stage IV (50%)
    • IVa: pleura/pericardium mets
    • IVb: distant mets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Indications for neoadjuvant/adjuvant therapy

A

Stage III-IV disease

(Cisplatin-based chemotherapy + XRT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Neoadjuvant/Adjuvant therapy regimen

A

Cisplatin-based chemotherapy + XRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Mechanism of action of Myasthenia Gravis

A

Autoantibodies to ACh receptor

(decreased transmission of AP at the NM junction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Demographics of Myasthenia Gravis

A
  • 2x MC in women
  • 2-3rd decade of life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Myasthenia Gravis Symptoms Grades

A
  • Grade I: focal disease-ocular muscle weakness
  • Grade II: Mild-moderate generalized disease
  • Grade III: Severe generalized disease
  • Grade IV: life-threatening weakness - respiratory failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Confirmatory tests for MG

A

Endrophonium (short acting anticholinesterase ) test

ACh Receptor assay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Medical treatment for MG

A

Pryidostigmine (long-acting anticholinesterase)

Plasmapheresis and IVIg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Indications for thymectomy for MG

A
  • Presence of thymic hyperplasia or thymoma
    • 30-50% of patients with thymoma have MG
    • 10-15% of patients with MG have a thymoma
  • Grade II-III MG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When should thymemctomy NOT be performed for MG

A

Myasthenic crisis

Grade IV disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Prevelence of primary mediastinal lymphoma

A

Rare (5-10% of anterior mediastinal masses)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

MC lymphoma subtype presenting as mediastinal mass

A

T-cell Non-Hodgkin’s lymphoma

(Hodgkins and lymphoblastic lymphoma also present in mediastinum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Diagnostic w/u for suspected mediastinal lymphoma

A
  • H&P
  • CXR
  • Chest CT
  • Tissue biopsy (percutaneous vs. open)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Survival for lymphoma based on __

A

Tumor grade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Treatmetn of lymphoma presenting in mediastinum

A

Chemotherapy and XRT

(Role of surgery: histologic diagnosis)

34
Q

Role of surgery for lymphoma presenting in mediastinum

A

Histologic diagnosis

35
Q

Prevelence of germ cell tumors among mediastinal masses

A

10-15% of mediastinal masses

36
Q

MC germ cell tumor in mediastinum

A

Teratoma

  • Assymptomatic (MC)
  • M:F (1:1)
37
Q

Characteristics of tertaoma

A
  • Assymptomatic (MC)
    • May present with infection or rupture into pleura or airway (coughing of hair or sebum)
  • M:F (1:1)
  • Serum tumor markers negative
  • Bx: well differentiated tissue from more than one cell line
38
Q

TOC for teratoma

A

Surgical excision

39
Q

MC malignant germ cell tumor of mediastinum

A

Seminoma

(males in 3rd decade)

40
Q

MC patient population with mediastinal Seminoma

A

Males in 3rd decade of life

41
Q

Diagnostic features of Seminoma

A
  • Slightly elevated Beta-HCG
  • CT: characteristic large, homogenous mass with smooth boarders
  • Slow growth
42
Q

TOC of Seminoma

A

Chemo/XRT

XRT sensitive (primary treatment)

Cisplatin-based chemotherapy (metastatic disease)

(Surgical resection reserved to residual disease, manifested as local growth of residual mass)

43
Q

Role of surgery for Seminoma

A

Residual disease manifested as local growth of a residual mass

(after XRT/chemotherapy)

44
Q

Characteristics of Non-seminomatous germ cell tumors of mediastinum

A
  • Young men (20-30 years old)
  • Elevated B-HCG, AFP, LDH
  • Rapid growth
  • Compress neighboring structures (symptomatic)
  • Metastatic disease common at presentation
  • Overall prognosis poor
45
Q

Three main subtypes of non-seminomatous GC tumors

A

(In order of frequency)

  • Yolk sac carcinoma
  • Embryonal carcinoma
  • Choriocarcinoma
46
Q

1st line treatment of non-seminomatous GC tumors

A

Cisplatin-based chemotherapy

(Surgical resection of residual tumor, regardless of response in tumor markers)

47
Q

Surgical approach for removal of most intrathoracic goiters

A

Cervical incision (upper sternal split may be required)

48
Q

MC middle mediastinal mass

A

Cysts

(bronchogenic, pericardial, enteric)

49
Q

MC cyst in middle mediastinum

A

Bronchogenic cysts (60%)

50
Q

Characteristics of bronchogenic cysts

A
  • Associated with airway
  • MC location = posterior to carina (subcarinal)
  • Symptoms of airway/esophageal compression; infection of the cyst
51
Q

Treatment of choice for bronchogenic cysts

A

Complete transthoracic surgical resection; even if asymptomatic to avoid future complications.

52
Q

Definition of pericardial cysts

A

Rare, benign cysts occuring at cardiophrenic angle (most often on right)

53
Q

Most common location for pericardial cysts

A

Right cardiophrenic angle

54
Q

Characteristics of pericardial cysts

A
  • CT imaging of thin, non-enhancing wall
    • Content has density similar to water
55
Q

TOC: pericardial cysts

A

Aspirate:

Surgical resection (symptomatic)

(Some argue for surgical resection of all pericardial cysts to avoid potential for rupture, erosion, or compression of heart or great vessels)

56
Q

Prevalence of neurogenic mediastinal tumors

A

15-20% of all mediastinal tumors

57
Q

Classic presentaiton and Cell of Origin of neurogenic mediastinal tumors

A

Presentation: Pain or neurologic dysfunction

Cell of origin: Neural Crest Cell

58
Q

3 major subtypes of Neurogenic tumors

A
  • Nerve sheath tumors
  • Ganglion cell tumors
  • Paraganglionic tumors
59
Q

MC neurogenic tumors

A

Nerve sheath tumors (40-70%)

60
Q

Most common location of nerve sheath tumors

A

Costovertebral/paravertebral sulcus

61
Q

Characteristics of nerve sheath tumors

A
  • Usually benign
    • neurofibrosarcoma (malignant variant)
      • increased mitotic activity
      • lack of encapsulation
  • 2 MC histologic types (schwannoma and neurofibroma)
62
Q

Neurogenic tumor that arises from sympathetic chain and adrenal medulla

A

Ganglion cell tumor

63
Q

Benign and Malignant subtypes of Ganglion cell tumor

A

Benign: ganglioneuroma (secrete VIP)

Malignant: Ganglioneuroblastoma

64
Q

Neurogenic tumors that secretes VIP

A

Ganglioneuroma (benign ganglion cell tumor)

Ganglioneuroblastoma (malignant ganglion cell tumor)

65
Q

MC extracranial malignancy in children and most aggressive ganglion cell tumor

A

Neuroblastoma

(secrete VIP and catacholamines)

66
Q

TOC for neuroblastoma

A

Surgical resection (localized disease) + adjuvant chemoradiation for residual diseaes

67
Q

Factors associated with poor prognosis for neuroblastoma

A
  • Metastatic disease
  • Age < 18 months
  • Histolgic differentiation
  • DNA ploidy
  • Presence of residual disease
  • N-myc amplification
  • High levels of neuron-specific enolase and LDH
68
Q

Tumors that arise from paraganglionic tissues in costovertebral area

A

Paraganglionic tumors

69
Q

Subtypes of paraganglionic tumors

A

Pheochromocytomas (catacholamine secretion_

Chemodectomas (hormonally inactive)

70
Q

TOC for paraganglionic tumor

A

Surgical resection (tumor capsule should be left intact)

(Chemodectomas respond to XRT)

71
Q

Name the Mass

A

Thymoma

72
Q

Name that mass

A

Well-differentiated teratoma

73
Q

Name that mass?

A

mediastinal lymphoma

74
Q

Name that Mass?

A

Mediastinal seminoma

75
Q

Name that mass?

A

Mediastinal Non-seminoma

76
Q

Name that Mass?

A

Bronchogenic cyst

77
Q

Masaoka staging

  • I
  • IIa
  • IIb
  • III
  • IVa
  • IVb
A
78
Q

Thymoma: treatment based on masaoka stage:

I

IIa

IIb

III

IVa

IVb

A
79
Q

Venous and arterial blood supply of the thymus.

A

Blood supply to the thymus comes from the internal thoracic artery as well as the superior and inferior thyroid arteries.

Drainage is to the left innominate vein as well as the superior, middle and inferior thyroid veins.

80
Q

Thymoma: “Recommended follow-up protocols by ITMIG”

A

General Thoracic Surgery Notecards (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions