Unlock the complexities of mediastinum tumors with our informative and comprehensive PowerPoint presentation (PPT) titled 'Mediastinum Tumors.' Designed for medical professionals, students, and anyone seeking to understand these rare but critical conditions, this presentation offers a thorough exploration of mediastinal tumors, their classification, diagnosis, and treatment options. Our PPT delves into the anatomy of the mediastinum, providing a solid foundation for understanding the diverse range of tumors that can develop in this vital thoracic region. Learn about the clinical significance of mediastinum tumors, their prevalence, and the potential impact on surrounding structures. We categorize mediastinal tumors, addressing their origins, including thymic tumors, neurogenic tumors, lymphomas, and more. Detailed insights into the histological characteristics of these tumors and their clinical implications are provided. The diagnostic section of our presentation guides you through the evaluation of mediastinum tumors, covering imaging techniques, biopsy procedures, and the importance of accurate staging. Keeping pace with the latest advancements in diagnostic tools, our PPT ensures you are well-informed about the most modern practices. Treatment options are discussed comprehensively, including surgery, radiation therapy, chemotherapy, and emerging targeted therapies. Explore the importance of a multidisciplinary approach in managing these tumors, and gain valuable knowledge for optimizing patient care. Our 'Mediastinum Tumors' PPT is enriched with high-quality visuals, radiological images, and case studies, providing a dynamic and engaging learning experience. Medical professionals can benefit from the wealth of information for clinical practice and patient education, while students will find it an invaluable resource for exam preparation. Families and patients facing mediastinum tumors can gain insights into their condition, treatment options, and the importance of an informed and empowered approach to healthcare decisions. Stay up to date with the rapidly evolving field of mediastinum tumor management. Our presentation is your trusted resource for deepening your understanding and facilitating informed decision-making. Start your journey towards comprehensive knowledge about mediastinum tumors with our 'Mediastinum Tumors PPT.

1. Mediastinum
Anatomy, Imaging and Serum Markers.
Surgical Biopsies and Resection of mediastinal masses, mediastinal
tumors.
Taner Yeke

2. MEDIASTINUM
• The mediastinum is an area found in the midline of the thoracic
cavity, that is surrounded by the left and right pleaural sacs.
• It’s divided in to the superior and inferior mediastinum, of which the
latter is larger.
• The inferior mediastinum is further divided into the anter,or, middle
and posterior mediastinum.

4. SUPERIOR MEDIASTINUM
The superior mediastinum is a space bounded anteriorly by the
manubrium of the sternum, and posteriorly by the bodies of T1-T4
vertebrae. It’s superior border is an oblique plane extending from the
jugular notch of the manubrium to the superior border of T1 vertebrae.
Whilst the inferior border is a tranverse plane extending from the
sternal angle to the T4-T5 intervertebral disc.

5. The contents of the superior mediastinum
• Thymus
• Trachea
• Esophagus
• Aortic arch
• Brachiocephalic trunk
• Left common carotid artery
• Left subclavian artery
• Internal thoracic arteries
• Superior vena cava
• Left superior intercostal vein
• Brachiocephalic veins
• Phrenic nerves
• Vagus nerves
• Left recurrent laryngeal branch of
the left vagus nerve
• Thoracic duct
• Lymph nodes and vessels,
• Other small arteries, veins and
nerves

6. Inferior Mediastinum
The inferior mediastinum extends from the inferior border of the
superior mediastinum to the diaphragm. It’s subdivided anterior-to-
posterior into three spaces:
• Anterior Mediastinum
• Middle Mediastinum
• Posterior Mediastinum

7. Anterior mediastinum
• Inferior portion of thymus
• Fat
• Connective tissue
• Lymph nodes
• Mediastinal branches of internal thoracic vessels
• Sternopericardial ligaments
Middle mediastinum
• Pericardial sac
• Heart
• Origins of great vessels: pulmonary trunk, ascending aorta, pulmonary veins, superior vena
cava, inferior vena cava
• Tracheal bifurcation and main bronchi
Posterior mediastinum
• Descending thoracic aorta and its branches
• Azygos and hemiazygos venous systems
• Thoracic duct & cisterna chyli
• Esophagus and esophageal plexus
• Vagus nerves
• Thoracic splanchnic nerves (greater, lesser, least)
Lymphatics

10. Mediastinal Biopsy
Mediastinal masses can be biopsied in 3 ways:
• Surgical Biopsy (Mediastinoscopy)
• Bronchoscopy
• Percutaneous Biopsy

11. Percutaneous Biopsy can be done in several
ways:
TRANSTERNAL:
A guide need le is passed through the sternum and multiple biopsies
are taken from the target mass with coaxial needle.
• It’s mostly applied in thymus or lymph node masses located behind
the sternum.

12. TRANSTERNAL
Biopsy from the mass located in the anterior mediastinum in the
patient with a transternal approach.

13. Parasternal:
It’s made by entering the tissues on the side. (Not inside the sternum)
• It’s suitable for masses located in the anterior mediastinum, but not
in the middle.

14. Parasternal:
• Biopsy from the mass located in the anterior mediastinum in the
patient with a parasternal approach.

15. Paravertebral:
• It’s entered from the edge of the spine to the target mass with a
guide needle, without entering the lung. And multiple biopsies are
taken with a coaxial needle.
• It’s used in the biopsy of masses in the posterior mediastinum.
- Lymph node
- Esophagus
- Trachea
- Bronchi

16. Coaxial Needle

17. Paravertebral:
• Biopsy from the subcarinal mass with the
paravertebral approach in the patient.

18. Transpulmonary
• In transsternal, parasternal and paravertebral approaches, there is no
risk of pneumothorax since the needle does not usually pass through
the lung.
• However, in some cases, it is not possible to reach the target audience
with these approaches. In these cases, as a last resort, the mass is
reached by crossing the lung (transpulmonary) and multiple biopsies
are taken with the coaxial system. Since the pleura is perforated twice
in the transpulmonary approach, the risk of pneumothorax is higher
than in normal lung biopsy.

19. Transpulmonary
• Biopsy from the right hilar mass in the patient
with a transpulmonary approach.

20. Mediastinal Masses
Mediastinal Division Most Common Tumors
Anterior Thymoma
Middle Lymphoma
Posterior Neurogenic Tumors
Compartment % Malignant
Anterior 59
Middle 29
Posterior 16

21. Anterior Mediastinal Masses
THYMUS:
• Thymoma
• Thymic Carcinoma
• Thymic Cyst
• Thymic Carcinoid
• Thymolipoma
Germ Cell Tumor:
• Seminoma
• Nonsemşnomatous Germ Cell
- Endodermal sinus tumor
- Embryonal cell carcinoma
- Choriocarcinoma
• Teratoma
- Mature
- Immature
Mediastinal Lymphoma:
• Hodking’s Lymphoma
• Non-Hodking’s Lymphoma
Endocrine Tumors:
• Thyroid tumors
• Parathyroid adenoma
Mesenchymal Tumors

22. Middle Mediastinal Masses
CYTST:
• Bronchogenic cyst
• Thoracic duct
• Meningoceles
Lymphadenopathy:
• Inflammatory
• Granulomatous
• Sarcoidosis
Mediastinal Lymphoma:
• Hodking’s Lymphoma
• Non-Hodking’s Lymphoma
Endocrine Tumors:
• Thyroid tumors
• Parathyroid adenoma
Tracheal Tumors
Vascular Tumors
Mesenchymal Tumors

23. Posterior Mediastinal Masses
Neurogenic Tumors:
• Peripheral Nerves
• Symphatetic Ganglia
• Paraganglia
Mediastinal Lymphoma:
• Hodking’s Lymphoma
• Non-Hodking’s Lymphoma
Endocrine Tumors:
• Thyroid tumors
• Parathyroid adenoma
Endocrine Tumors
Esophageal Tumors & Cyst
Mesenchymal Tumors

24. Tumors of Thymus
• Thymomas
• Thymic carcinomas
• Thymic lymphomas
• Carcinoids
• Thymolipomas
• Secondaries

25. Thymoma
• Most common primary anterior mediastinal tumor
• M=F, most >40
• Half of patients suffer have associated parathymic syndromes:
- myasthenia gravis
- hypogammaglobulinemia
- pure red cell aplasia

26. • 1/3 have chest pain, cough or dyspnea on presentation
• Myasthenia gravis occurs in 30-50% of patients with thymoma.
• Pure red cell aplasia occurs in 5%, but thymoma occurs in 50% of
patients with red cell aplasia.

27. • Lobulated mass in the anterior mediastinum

28. Thymoma

29. Thymic Carcinoid
Carcinoid tumors (neuroendocrine tumors) of the thymus are very rare,
accounting for <5% of all neoplasms of the anterior mediastinum. They
originate from the normal thymic Kulchitsky cells, which belong to the
amine precursor uptake and dacarboxylation (APUD) group.
Presentation:
• Men aged 30 to 50 years
• (Male/female ratio: 3/1)
• Rarely associated with carcinoid syndrome.
• Associated endocrine abnormalities: Cushing’s syndrome due to
ectopic ACTH or MEN
• 73% have regional lymph node and/or distant osteoblastic bone mets.

30. Thymic Carcinoma
• M<F, 40s
• Thymic carcinomas are less common then thymomas, more
aggressive tih a higher propensity for capsular invasion
• Early local invasion, widespread lymphatic and hematogenous
metastases
• Cliniclly, patients present initially with tussis, dyspnea, pleuritic chest
pain, phrenic nerve palsy or superior vena cava.

34. Mediastinal Lymphoma

45. Mediastinal Tumor Resection
Reasons for Procedure:
Tumors in this area can put pressure on heart, lungs, spine and esophagus.
It can also effect nearby nerves and blood vessels. This surgery can help to
remove the tumors to ease any problems they may have caused. It is often
part of treatment for cancer in this area.
Possible Complications
• Problems from the procedure are rare, but all procedures have some risk. Your doctor will review
potential problems, such as:
• Damage to the areas surrounding the tumor, including the heart, lungs, and spinal cord
• Fluid collecting between the lung tissue lining and the wall of the chest cavity
• Lung collapse
• Drainage, infection, or bleeding

46. What to Expect?
Before the operation, images of the following structures can be
taken.
• X-ray
• MRI scan
• CT scan
• PET scan