Giant tumors of the posterior mediastinum: a narrative review of surgical treatment

Abstract

Background and objective: The posterior mediastinum is a potential space along the paravertebral sulci or between the posterior aspect of the pericardium and the vertebrae. This compartment is classically the most frequent location site of neurogenic tumors. Whereas neurofibroma and schwannoma are neurogenic tumors that commonly arise from peripheral nerves, sympathetic nerves are the origin of ganglioneuroma, neuroblastoma, ganglioneuroblastoma, and neuroectodermal cells closely associated with autonomic nerves are the origin of paragangliomas and pheochromocytomas. Additionally, tumors from the esophagus, tumors of mesenchymal origin, lymphoma, ectopic goiter, and diseases with lymph node hyperplasia may also settle on this compartment. The objectives are to identify term "giant posterior mediastinal tumor" and the etiology, clinical features, diagnostic methods, pathological types, surgical methods applied, and technical details of these methods for the treatment of these tumors.

Methods: In this review, the term "giant tumor" was used to define tumors larger than 10 cm settled in the posterior mediastinum. PubMed database was searched with keywords "posterior mediastinum, giant mass" or "posterior mediastinum, tumor, giant" limited to English language and full-text available studies published between years 1984-2021.

Key content and findings: As a result of the literature review with the relevant terms, 23 case reports were found in accordance with the inclusion criteria. We detected the most common giant posterior mediastinum tumors were neurogenic origin (schwannoma, ganglioneuroma, ganglioneuroblastoma, triton tumor) in that review. The most common surgical approach was posterolateral thoracotomy. Treatment response to surgical total excision was good in most of cases.

Conclusions: The definitive diagnosis and treatment of giant posterior mediastinal tumors is made by surgical excision. Diagnostic procedures and subsequent surgical planning may vary depending on the origin and localization. Adjuvant treatment and follow-up should be conducted on the histopathological features.

Keywords: Giant tumor; posterior mediastinum; surgery.

Figure 1

A giant posterior mediastinal mass located in the prevertebral area. (A,B) Axial and sagittal view of the mass on chest CT. (C) Dissection of the mass from the outer wall of the esophagus. (D) Buttressing of the esophageal wall with pericardial fat tissue. CT, computed tomography.

Figure 2

A giant posterior cystic teratoma occupies half of the hemithorax. (A,B) Coronal and sagittal view of the mass on chest CT. (C) Intraoperative view. (D) Macroscopic view of the en bloc resection material. CT, computed tomography.

Figure 3

Hockey stick incision to allow concomitant laminectomy.

Figure 4

Posterior mediastinal giant paraganglioma. (A) Chest CT view. (B) Intraoperative view of the adjacent anatomic structures. (C,D) Organoid array uniform-looking neoplastic formation, including minimal atypia and characterized by spindle cells in patches (H&E ×200). Cytoplasmic dying with immunohistochemically diffused strength in neoplastic cells (kromogranin ×200). CT, computed tomography; H&E, hematoxylin and eosin.