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. 2023 Aug 15:7:24.
doi: 10.21037/med-22-49. eCollection 2023.

Giant middle mediastinal lesions: when tumor size correlates with mesenchymal origin-a retrospective single-center analysis

Stéphane Collaud  1   2 , Theresa Stork  1   2 , Hafsa Kaman  1   2 , Sebastian Bauer  3 , Christoph Pöttgen  4 , Hans-Ulrich Schildhaus  5 , Bastian Schmack  6 , Clemens Aigner  1
Affiliations

Giant middle mediastinal lesions: when tumor size correlates with mesenchymal origin-a retrospective single-center analysis

Stéphane Collaud et al. Mediastinum. .

Abstract

Background: The International Thymic Malignancy Interest Group (ITMIG) proposed an internationally accepted division of the mediastinum into three compartments based on computed tomography (CT): anterior (prevascular), middle (visceral) and posterior (paravertebral) compartment. There is no generally accepted definition for the term "giant" when applied to middle mediastinal lesions. We defined the term "giant" and described our surgical experience in treating patients with giant lesions of the middle mediastinum.

Methods: CT imaging of patients operated in our center from January 2016 to August 2021 for mediastinal lesions was reviewed. Lesions were categorized to one of the ITMIG-defined compartments. Lesion size at diagnosis was measured at its largest diameter on axial CT imaging. Giant middle mediastinal lesions were defined as lesions having a size ≥90th percentile of our middle mediastinal lesion cohort. Patients with giant middle mediastinal lesions were further analyzed.

Results: Thirty-six patients (23%) had lesions located in the middle mediastinal compartment. Most common diagnoses were mediastinal cysts (n=10, 28%), metastatic lesions (n=6, 17%), lymphomas (n=5, 14%), and sarcomas (n=3, 8%). Ninetieth percentile lesion size was 73 mm. As per definition, four patients had giant middle mediastinal lesions. All these four lesions were of mesenchymal origin including oesophageal leiomyoma, synovial sarcoma, leiomyosarcoma and undifferentiated round cell sarcoma. Resection was performed through posterolateral thoracotomy or sternotomy, with or without cardiopulmonary bypass.

Conclusions: The term "giant" could be defined as a mass larger or equal to 73 mm. This definition selected specifically lesions with mesenchymal origin and may therefore guide diagnostic algorithm and patient management.

Keywords: Giant; mesenchymal tumors; middle mediastinum; sarcoma; surgery.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-22-49/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
CT shows a 73 mm oesophageal leiomyoma. CT, computed tomography.
Figure 2
Figure 2
CT shows an 84 mm synovial sarcoma located anteriorly and inferiorly to the tracheal carina, compressing the right pulmonary artery. CT, computed tomography.
Figure 3
Figure 3
Preoperative imaging and intraoperative situs in a patient with leiomyosarcoma of the middle mediastinum. (A) MRI shows a 90 mm leiomyosarcoma of the middle mediastinum. (B) Intraoperative picture after leiomyosarcoma resection. The RMB and Oe were not infiltrated by the tumor. MRI, magnetic resonance imaging; RMB, right main bronchus; Oe, oesophagus.
Figure 4
Figure 4
CT shows a 120 mm undifferentiated round cell sarcoma with compression of the inferior vena cava and left atrium. CT, computed tomography.
See this image and copyright information in PMC

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