A study of clinical characteristicsof mediastinal mass

Abstract

Background: Mediastinal tumours are uncommon lesions encountered in clinical practice. There has been a significant increase in the incidence of malignant mediastinal tumours over the past four decades. The presentation varies from asymptomatic lesions detected incidentally on imaging to severe life threatening presentations.

Aim and objectives: The study was conducted to assess the clinical characteristics, types, treatment modalities and outcome of mediastinal masses.

Materials and methods: In this two year prospective study, a total of 35 cases with or without symptoms of mediastinal mass, confirmed by Computed Tomography (CT) imaging were included. The results were expressed as percentages or proportions.

Results: Maximum numbers of patients (25.71%) were seen in the 3(rd) decade and majority (94.3%) was symptomatic at presentation. Malignant lesions (68.57%) were more common than benign (31.43%) and lymphoma was the commonest malignant tumour (50%). Mediastinal widening on chest X-ray was seen in 27 cases (77.14%), pleural effusion and lung mass in 5 cases each (14.29%). On CT imaging and sub-classification, anterior mediastinum was the commonest compartment involved (42.86%).

Conclusion: Mediastinal masses are usually symptomatic at presentation. Majority of the masses were malignant lesions and the symptoms of mediastinal obstruction was significantly higher in malignant lesions and anterior mediastinal masses. Lymphoma was the most frequent primary mediastinal mass and thymoma constituted the commonest benign anterior mediastinal tumour.

Keywords: Computed Tomography (CT); Lymphoma; Mediastinal mass; Thymoma.

[Table/Fig-3]:

(A)-CT showing encapsulated, multi-septated fluid density lesion in the anterior mediastinum measuring about 9.5 x 6.5 cms. (Teratoma) (B)-CT showing lobulated mass lesion measuring 12.5 x 7.5 x 6.6 cms in the anterior and middle mediastinum. (NHL) (C)-CT showing peripherally enhancing conglomerate lymph nodes with central necrosis in the midline and right paramedian region compressing superior vena-cava and encasing trachea. (Mediastinal tuberculosis)

[Table/Fig-4]:

(A)- Teratoma: Lesional tissue showing cartilage with respiratory mucosa (H&E stain X100). [Inset: glial tissue with respiratory mucosa]. (B)- Spindle cell Thymoma (type A).Oval to spindle shaped epithelial cells arranged in fascicles (H&E stain X100). (C)- Nodular sclerosis type of Hodgkin’s lymphoma. Lacunar type of Reed Sternberg cell seen amidst a background of lymphocytes and plasma cells (H&E stain X100).

[Table/Fig-5]:

Types of mediastinal tumours