Abstract
The mediastinum contains a variety of vital structures and organs, including the thymus, lymph nodes, adipose tissues, vascular structures, nerves, and esophagus, all of which can give rise to various masses and other nonneoplastic abnormalities. Imaging is the integral part of the workup for mediastinal tumors, specifically chest computed tomography (CT) and in equivocal cases magnetic resonance imaging (MRI), leading in many cases to a confident presumptive diagnosis, even without necessitating biopsy, surgery, or other confirmatory testing.
In this chapter, we focus on discussing the clinical manifestations, diagnosis, and treatment of non-thymic tumors, specifically germ cell tumors, lymphoma, and mesenchymal tumors. Although this is discussed in prior chapters, we start by discussing a generalized structured imaging approach that radiologists can use when evaluating anterior mediastinal tumors in general, aided by useful clinical and laboratory information when made available. Thymic benign and malignant tumors are discussed in detail in other chapters.
Keywords
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- AFP:
-
Alpha-fetoprotein
- CBC:
-
Complete blood count
- CT:
-
Computed tomography
- ESR:
-
Erythrocyte sedimentation rate
- FDG:
-
Fluorodeoxyglucose
- GCT:
-
Germ cell tumor
- HL:
-
Hodgkin’s lymphoma
- HU:
-
Hounsfield units
- LBCL:
-
Large B-cell lymphoma
- LDH:
-
Lactate dehydrogenase
- MRI:
-
Magnetic resonance imaging
- PET/CT:
-
Positron-emission tomography/computed tomography
- SVC:
-
Superior vena cava
- β-hCG:
-
Beta-human chorionic gonadotropin
References
Felson B. Chest roentgenology. Philadelphia, PA: Saunders; 1973.
Carter BW, Tomiyama N, Bhora FY, et al. A modern definition of mediastinal compartments. J Thorac Oncol. 2014;9:S97–101.
Carter BW, Benveniste MF, Madan R, et al. ITMIG Classification of mediastinal compartments and multidisciplinary approach to mediastinal masses. Radiographics. 2017;37:413–36.
Carter BW, Marom EM, Detterbeck FC. Approaching the patient with an anterior mediastinal mass: a guide for clinicians. J Thorac Oncol. 2014;9:S102–9.
Osserman KE, Genkins G. Studies in myasthenia gravis: review of a twenty-year experience in over 1200 patients. Mt Sinai J Med. 1971;38:497–537.
Davis RD Jr, Oldham HN Jr, Sabiston DC Jr. Primary cysts and neoplasms of the mediastinum: recent changes in clinical presentation, methods of diagnosis, management, and results. Ann Thorac Surg. 1987;44:229–37.
Lewis BD, Hurt RD, Payne WS, et al. Benign teratomas of the mediastinum. J Thorac Cardiovasc Surg. 1983;86:727–31.
Adebonojo SA, Nicola ML. Teratoid tumors of the mediastinum. Am Surg. 1976;42:361–5.
Moeller KH, Rosado-de-Christenson ML, Templeton PA. Mediastinal mature teratoma: imaging features. AJR Am J Roentgenol. 1997;169:985–90.
Takeda S, Miyoshi S, Ohta M, et al. Primary germ cell tumors in the mediastinum: a 50-year experience at a single Japanese institution. Cancer. 2003;97:367–76.
Feo CF, Chironi G, Porcu A, et al. Videothoracoscopic removal of a mediastinal teratoma. Am Surg. 1997;63:459–61.
Arai K, Ohta S, Suzuki M, et al. Primary immature mediastinal teratoma in adulthood. Eur J Surg Oncol. 1997;23:64–7.
Donadio AC, Motzer RJ, Bajorin DF, et al. Chemotherapy for teratoma with malignant transformation. J Clin Oncol. 2003;21:4285–91.
Moran CA, Suster S, Przygodzki RM, et al. Primary germ cell tumors of the mediastinum: II. Mediastinal seminomas--a clinicopathologic and immunohistochemical study of 120 cases. Cancer. 1997;80:691–8.
Dulmet EM, Macchiarini P, Suc B, et al. Germ cell tumors of the mediastinum. a 30-year experience. Cancer. 1993;72:1894–901.
Bohle A, Studer UE, Sonntag RW, et al. Primary or secondary extragonadal germ cell tumors? J Urol. 1986;135:939–43.
Bokemeyer C, Nichols CR, Droz JP, et al. Extragonadal germ cell tumors of the mediastinum and retroperitoneum: results from an international analysis. J Clin Oncol. 2002;20:1864–73.
Strollo DC, Rosado-de-Christenson ML. Primary mediastinal malignant germ cell neoplasms: imaging features. Chest Surg Clin N Am. 2002;12:645–58.
Shin MS, Ho KJ. Computed tomography of primary mediastinal seminomas. J Comput Assist Tomogr. 1983;7:990–4.
Rosado-de-Christenson ML, Templeton PA, Moran CA. From the archives of the AFIP. Mediastinal germ cell tumors: radiologic and pathologic correlation. Radiographics. 1992;12:1013–30.
Hainsworth JD, Greco FA. Extragonadal germ cell tumors and unrecognized germ cell tumors. Semin Oncol. 1992;19:119–27.
Hartmann JT, Nichols CR, Droz JP, et al. Hematologic disorders associated with primary mediastinal nonseminomatous germ cell tumors. J Natl Cancer Inst. 2000;92:54–61.
Orazi A, Neiman RS, Ulbright TM, et al. Hematopoietic precursor cells within the yolk sac tumor component are the source of secondary hematopoietic malignancies in patients with mediastinal germ cell tumors. Cancer. 1993;71:3873–81.
Nichols CR. Mediastinal germ cell tumors. Clinical features and biologic correlates. Chest. 1991;99:472–9.
Fizazi K, Culine S, Droz JP, et al. Primary mediastinal nonseminomatous germ cell tumors: results of modern therapy including cisplatin-based chemotherapy. J Clin Oncol. 1998;16:725–32.
Pina-Oviedo S, Moran CA. Primary mediastinal classical Hodgkin lymphoma. Adv Anat Pathol. 2016;23:285–309.
Strollo DC. Rosado de Christenson ML, and Jett JR Primary mediastinal tumors. Part 1: Tumors of the anterior mediastinum. Chest. 1997;112:511–22.
Shahrzad M, Le TS, Silva M, et al. Anterior mediastinal masses. AJR Am J Roentgenol. 2014;203:W128–38.
Itti E, Meignan M, Berriolo-Riedinger A, et al. An international confirmatory study of the prognostic value of early PET/CT in diffuse large B-cell lymphoma: comparison between Deauville criteria and DeltaSUVmax. Eur J Nucl Med Mol Imaging. 2013;40:1312–20.
Schaefer NG, Hany TF, Taverna C, et al. Non-Hodgkin lymphoma and Hodgkin disease: coregistered FDG PET and CT at staging and restaging--do we need contrast-enhanced CT? Radiology. 2004;232:823–9.
Hutchings M, Barrington SF. PET/CT for therapy response assessment in lymphoma. J Nucl Med. 2009;50(Suppl 1):21S–30S.
Zinzani PL, Stefoni V, Tani M, et al. Role of [18F]fluorodeoxyglucose positron emission tomography scan in the follow-up of lymphoma. J Clin Oncol. 2009;27:1781–7.
Lister TA, Crowther D, Sutcliffe SB, et al. Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin’s disease: Cotswolds meeting. J Clin Oncol. 1989;7:1630–6.
Diehl V, Thomas RK, Re D, Part II. Hodgkin’s lymphoma--diagnosis and treatment. Lancet Oncol. 2004;5:19–26.
Nguyen LN, Ha CS, Hess M, et al. The outcome of combined-modality treatments for stage I and II primary large B-cell lymphoma of the mediastinum. Int J Radiat Oncol Biol Phys. 2000;47:1281–5.
Jacobson JO, Aisenberg AC, Lamarre L, et al. Mediastinal large cell lymphoma. An uncommon subset of adult lymphoma curable with combined modality therapy. Cancer. 1988;62:1893–8.
Savage KJ, Al-Rajhi N, Voss N, et al. Favorable outcome of primary mediastinal large B-cell lymphoma in a single institution: the British Columbia experience. Ann Oncol. 2006;17:123–30.
Tateishi U, Muller NL, Johkoh T, et al. Primary mediastinal lymphoma: characteristic features of the various histological subtypes on CT. J Comput Assist Tomogr. 2004;28:782–9.
Hamlin PA, Portlock CS, Straus DJ, et al. Primary mediastinal large B-cell lymphoma: optimal therapy and prognostic factor analysis in 141 consecutive patients treated at Memorial Sloan Kettering from 1980 to 1999. Br J Haematol. 2005;130:691–9.
Rieger M, Osterborg A, Pettengell R, et al. Primary mediastinal B-cell lymphoma treated with CHOP-like chemotherapy with or without rituximab: results of the Mabthera International Trial Group study. Ann Oncol. 2011;22:664–70.
Juweid ME, Stroobants S, Hoekstra OS, et al. Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol. 2007;25:571–8.
Lee KH, Song KS, Kwon Y, et al. Mesenchymal tumours of the thorax: CT findings and pathological features. Clin Radiol. 2003;58:934–44.
Macchiarini P, Ostertag H. Uncommon primary mediastinal tumours. Lancet Oncol. 2004;5:107–18.
McCarville MB, Christie R, Daw NC, et al. PET/CT in the evaluation of childhood sarcomas. AJR Am J Roentgenol. 2005;184:1293–304.
Raney RB, Walterhouse DO, Meza JL, et al. Results of the Intergroup Rhabdomyosarcoma Study Group D9602 protocol, using vincristine and dactinomycin with or without cyclophosphamide and radiation therapy, for newly diagnosed patients with low-risk embryonal rhabdomyosarcoma: a report from the Soft Tissue Sarcoma Committee of the Children’s Oncology Group. J Clin Oncol. 2011;29:1312–8.
Dorfman HD, Czerniak B. Bone cancers. Cancer. 1995;75:203–10.
Ostergaard ML, Petersen RH, Kalhauge A. A chondrosarcoma in the anterior mediastinum mimicking a thymoma. Acta Radiol Open. 2015;4:2058460115595659.
Widhe B, Bauer HC, Scandinavian Sarcoma G. Surgical treatment is decisive for outcome in chondrosarcoma of the chest wall: a population-based Scandinavian Sarcoma Group study of 106 patients. J Thorac Cardiovasc Surg. 2009;137:610–4.
Angelini A, Guerra G, Mavrogenis AF, et al. Clinical outcome of central conventional chondrosarcoma. J Surg Oncol. 2012;106:929–37.
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Raad, R.A. (2018). Imaging of Non-thymic Anterior Mediastinal Tumors. In: Anzidei, M., Anile, M. (eds) Diagnostic Imaging for Thoracic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-89893-3_14
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DOI: https://doi.org/10.1007/978-3-319-89893-3_14
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