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Imaging of Non-thymic Anterior Mediastinal Tumors

  • Roy A. Raad
Chapter

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

Anterior mediastinum Chest CT Chest MR FDG PET/CT Lymphoma Seminoma Teratoma Nonseminomatous germ cell tumor Mesenchymal tumor 

Abbreviations

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

  1. 1.
    Felson B. Chest roentgenology. Philadelphia, PA: Saunders; 1973.Google Scholar
  2. 2.
    Carter BW, Tomiyama N, Bhora FY, et al. A modern definition of mediastinal compartments. J Thorac Oncol. 2014;9:S97–101.CrossRefPubMedGoogle Scholar
  3. 3.
    Carter BW, Benveniste MF, Madan R, et al. ITMIG Classification of mediastinal compartments and multidisciplinary approach to mediastinal masses. Radiographics. 2017;37:413–36.CrossRefPubMedGoogle Scholar
  4. 4.
    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.CrossRefPubMedGoogle Scholar
  5. 5.
    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.PubMedGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    Lewis BD, Hurt RD, Payne WS, et al. Benign teratomas of the mediastinum. J Thorac Cardiovasc Surg. 1983;86:727–31.PubMedGoogle Scholar
  8. 8.
    Adebonojo SA, Nicola ML. Teratoid tumors of the mediastinum. Am Surg. 1976;42:361–5.PubMedGoogle Scholar
  9. 9.
    Moeller KH, Rosado-de-Christenson ML, Templeton PA. Mediastinal mature teratoma: imaging features. AJR Am J Roentgenol. 1997;169:985–90.CrossRefPubMedGoogle Scholar
  10. 10.
    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.CrossRefPubMedGoogle Scholar
  11. 11.
    Feo CF, Chironi G, Porcu A, et al. Videothoracoscopic removal of a mediastinal teratoma. Am Surg. 1997;63:459–61.PubMedGoogle Scholar
  12. 12.
    Arai K, Ohta S, Suzuki M, et al. Primary immature mediastinal teratoma in adulthood. Eur J Surg Oncol. 1997;23:64–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Donadio AC, Motzer RJ, Bajorin DF, et al. Chemotherapy for teratoma with malignant transformation. J Clin Oncol. 2003;21:4285–91.CrossRefPubMedGoogle Scholar
  14. 14.
    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.CrossRefPubMedGoogle Scholar
  15. 15.
    Dulmet EM, Macchiarini P, Suc B, et al. Germ cell tumors of the mediastinum. a 30-year experience. Cancer. 1993;72:1894–901.CrossRefPubMedGoogle Scholar
  16. 16.
    Bohle A, Studer UE, Sonntag RW, et al. Primary or secondary extragonadal germ cell tumors? J Urol. 1986;135:939–43.CrossRefPubMedGoogle Scholar
  17. 17.
    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.CrossRefPubMedGoogle Scholar
  18. 18.
    Strollo DC, Rosado-de-Christenson ML. Primary mediastinal malignant germ cell neoplasms: imaging features. Chest Surg Clin N Am. 2002;12:645–58.CrossRefPubMedGoogle Scholar
  19. 19.
    Shin MS, Ho KJ. Computed tomography of primary mediastinal seminomas. J Comput Assist Tomogr. 1983;7:990–4.CrossRefPubMedGoogle Scholar
  20. 20.
    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.CrossRefPubMedGoogle Scholar
  21. 21.
    Hainsworth JD, Greco FA. Extragonadal germ cell tumors and unrecognized germ cell tumors. Semin Oncol. 1992;19:119–27.PubMedGoogle Scholar
  22. 22.
    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.CrossRefPubMedGoogle Scholar
  23. 23.
    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.CrossRefPubMedGoogle Scholar
  24. 24.
    Nichols CR. Mediastinal germ cell tumors. Clinical features and biologic correlates. Chest. 1991;99:472–9.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    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.CrossRefPubMedGoogle Scholar
  26. 26.
    Pina-Oviedo S, Moran CA. Primary mediastinal classical Hodgkin lymphoma. Adv Anat Pathol. 2016;23:285–309.CrossRefPubMedGoogle Scholar
  27. 27.
    Strollo DC. Rosado de Christenson ML, and Jett JR Primary mediastinal tumors. Part 1: Tumors of the anterior mediastinum. Chest. 1997;112:511–22.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Shahrzad M, Le TS, Silva M, et al. Anterior mediastinal masses. AJR Am J Roentgenol. 2014;203:W128–38.CrossRefPubMedGoogle Scholar
  29. 29.
    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.CrossRefPubMedGoogle Scholar
  30. 30.
    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.CrossRefPubMedGoogle Scholar
  31. 31.
    Hutchings M, Barrington SF. PET/CT for therapy response assessment in lymphoma. J Nucl Med. 2009;50(Suppl 1):21S–30S.CrossRefPubMedGoogle Scholar
  32. 32.
    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.CrossRefPubMedGoogle Scholar
  33. 33.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Diehl V, Thomas RK, Re D, Part II. Hodgkin’s lymphoma--diagnosis and treatment. Lancet Oncol. 2004;5:19–26.CrossRefPubMedGoogle Scholar
  35. 35.
    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.CrossRefPubMedGoogle Scholar
  36. 36.
    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.CrossRefPubMedGoogle Scholar
  37. 37.
    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.CrossRefPubMedGoogle Scholar
  38. 38.
    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.CrossRefPubMedGoogle Scholar
  39. 39.
    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.CrossRefPubMedGoogle Scholar
  40. 40.
    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.CrossRefPubMedGoogle Scholar
  41. 41.
    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.CrossRefPubMedGoogle Scholar
  42. 42.
    Lee KH, Song KS, Kwon Y, et al. Mesenchymal tumours of the thorax: CT findings and pathological features. Clin Radiol. 2003;58:934–44.CrossRefPubMedGoogle Scholar
  43. 43.
    Macchiarini P, Ostertag H. Uncommon primary mediastinal tumours. Lancet Oncol. 2004;5:107–18.CrossRefPubMedGoogle Scholar
  44. 44.
    McCarville MB, Christie R, Daw NC, et al. PET/CT in the evaluation of childhood sarcomas. AJR Am J Roentgenol. 2005;184:1293–304.CrossRefPubMedGoogle Scholar
  45. 45.
    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.CrossRefPubMedGoogle Scholar
  46. 46.
    Dorfman HD, Czerniak B. Bone cancers. Cancer. 1995;75:203–10.CrossRefPubMedGoogle Scholar
  47. 47.
    Ostergaard ML, Petersen RH, Kalhauge A. A chondrosarcoma in the anterior mediastinum mimicking a thymoma. Acta Radiol Open. 2015;4:2058460115595659.PubMedPubMedCentralGoogle Scholar
  48. 48.
    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.CrossRefPubMedGoogle Scholar
  49. 49.
    Angelini A, Guerra G, Mavrogenis AF, et al. Clinical outcome of central conventional chondrosarcoma. J Surg Oncol. 2012;106:929–37.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyNew York University School of MedicineNew YorkUSA
  2. 2.Department of RadiologySt. George Hospital University Medical CenterBeirutLebanon

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