Pathology of mediastinal peripheral tumours

2021-01-30 12:00 AM

The mediastinum is the location of many clusters of lymph nodes, lymph node stations, so it often denotes lymphopathy. There are many remaining lung relics that are the origin of lung tumours, teratomas.

Outline

A mediastinal tumour is a tumour that can be found at any position of the mediastinum. Includes primary, secondary tumours; good and evil. The most common pathology is thymus adenoma, a nerve tumour that can be found at all ages, all sexes.

Mediastinal surgery

Is it a narrow compartment with upper and lower limits, front and back, two sides?

Divided into 3 parts:

Anterior (thymus, ascending aorta, superior vena cava, anonymous vein).

Middle (trachea, main bronchus, veins, large vessels, diaphragmatic nerves, pulmonary artery, pulmonary veins ...)

Posterior (oesophagus, X-nerve, sympathetic, thoracic aorta, single vein).

Divided into 3 floors: upper, middle, lower.

Pathophysiology of mediastinal tumours

This is a cramped anatomical compartment containing many different organs, so the mediastinal syndrome is a sign of compression of these organs.

 Depending on the location of the tumour, or not, there are cases where the tumour is small but has severe compression and vice versa, there are cases where the tumour has grown but discovered by accident.

The mediastinum is the location of many clusters of lymph nodes, lymph node stations, so it often denotes lymph paths. There are many remaining lung relics that are the origin of lung tumours, teratomas.

Clinical

The first period happened silently at an unknown time.

Random detection

During a routine physical exam, chest X-ray.

Mediastinal syndrome

Respiratory signs: Cough, difficulty breathing, chest pain.

Digestive signs: Difficulty swallowing, hiccups.

Nerve signs:

Claude Bernard Horner Syndrome.

Hoarseness (due to reversible nerve compression).

Pancoast - Tobias syndrome.

Diaphragmatic arch paralysis.

Signs of myasthenia gravis (seen in thymoma).

Signs of venous compression:

Upper aortic compression: Swelling coat, collateral circulation, cyanosis, headache, somnolence.

Lower aortic compression: enlarged liver, ascites, lower extremities oedema (uncommon).

Signs of chest tube compression: Pleural effusion (chylothorax).

Chest wall signs: swelling of the sternum (above or below the collarbone).

Body signs:

Change in body condition.

Nodules of the neck on the collarbone.

Pierre - Marie syndrome.

Diagnosis

Based on the sign of mediastinal compression (as above).

Chest X-ray

Standard chest radiograph (straight and inclined).

The shadow goes immediately to the mediastinum, pushing the organs in the mediastinum aside.

Contrast esophagitis

Give the patient Baryte oral and chest x-ray showing that the oesophagus is squeezed or pushed differently depending on the position and size of the tumour.

Chest computed tomography

Determine the exact position, size and relevance of the mediastinal tumour.

Intermediate with inflatable

Pumping 400-1000ml of oxygen into the mediastinum through a needle pierced from the stoma, imaging will show the correlation of the tumour with neighbouring organs.

Angiography

If there is suspicion of the correlation of the tumour with the large blood vessels in the mediastinum.

Differential diagnosis

 Acute mediastinal syndrome: mediastinal purulent inflammation, mediastinal abscess, oesophageal perforation, purulent inflammation of the mediastinal lymph nodes.

Chronic mediastinal syndrome: fibrosis of the mediastinum, chronic fibrosis (tuberculosis, syphilis), upper aortic syndrome.

Patient pseudo-mediastinal tumours: X-ray with mediastinal edge shaded: Lung cancer, pleural effusion, mesenteric lung abscess.

Diagnosis of the zone

Anterior mediastinal tumour

Upper: Thyroid, thymus.

Middle layer: Thymus tumours, lung tumours.

Lower layer: Cyst of pleura, pericardium, adipoma.

Median middle

Cysts from the bronchi, lymphadenopathy.

The median after

Nerve tumours, meningeal hernias, tuberculoma (Pott), oesophageal tumours, diaphragmatic hernias, lymphadenopathy.

Some common diseases

Thyroid Cancer

Chest neck type, sunk goitre.

The patient swallows a lower lump that rises above the sternum.

Hoarseness is due to reverse insertion.

 X-ray: Concentrated shape moves with swallowing movement.

Blink shooting I131.

Risk of cancer, compression of large blood vessels (surgery)

Thymus cancer

Development from the ruins of the thymus does not completely regress. Often causes myasthenia gravis (appearance of anti-rhabdomyolysis antibodies, affecting the nerve-muscle snap, causing loss of muscle tone).

An inflatable X-ray.

Computed tomography: There is an image of a black cloud that is slanted downwards and outwards like a banana.

Lung cancer

Lung cancer of the same type

Cyst from the bronchi (round, well-defined, at the tracheal junction, not moving when swallowing); pleural-pericardial cyst (circular shading of the heart and lower mediastinum), cyst of the oesophagus.

Heterologous lung cancer

Tumours and epidermal cysts (developing from embryonic relics, sebum inside, hair, teeth, cartilage, bones, hair ...)

Fatty tumour

Large in size, benign, creating an even shadow, sometimes covering the heart ball.

Medial lymph node disease

The enlarged lymph nodes are clustered along the trachea, right-left lung hilum, tracheal junction.

On the radiograph: The shadows are uniform, the edge is clear, the ball is round or many arcs if there are many overlapping nodes.

Causes of the lymph nodes: Primary tuberculosis, Hodgkin, carcinoma (breast, uterus, bronchopulmonary, testes, prostate, digestive ...), Besnier Boeck - Schaumann disease.

Nervous tumours

Development from nerve components: sympathetic ganglion, spinal cord roots. Typical X-ray images with uniformly dense shadows, clear margins in the ribs of the spine, overlapping images of the spine on slant film.

The principles of treatment

Mediastinal tumours are often latent, rarely detected early.

The main treatment is surgery to remove the tumour

However, for cancer cases, they often infiltrate neighbouring organizations, so surgery is often limited.

Postoperative results depend on the nature of the lesion. In cancer cases where surgery is not indicated, chemotherapy and radiation therapy are used.

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