anatomy , clinical correlation , approach to mediastinal tumors, overview of different mediastinal tumors . slides are made very simple and easy .

1. MEDIASTINAL TUMORS

2. CONTENTS
• ANATOMY AND CLINICAL CORRELATION
• APPROACH TO A MEDIATINAL TUMOR
• OVERVIEW OF DIFFERENT MEDIASTNAL TUMOR

3. ANATOMY OF MEDIASTINUM
• BORDERS OF MEDIASTINUM
• COMPARTMENTS OF MEDIASTINUM
• CONTENTS OF MEDIASTINUM
ANTERO
SUPERIOR
• THYMUS
•LYPMH NODES
•FAT
MIDDLE
• PERICARDIUM
•HEART
•ASCENDING AORTA
•SVC
•PULMONARY VEIN
•PULMONARY ARTERY
•PHRENIC NERVE
•BIFURCATION OF
TRACHEA
•LYMPHNODE
POSTERIOR
•OESOPHAGUS
•DESCENDING AORTA
•AZYGOS VEIN
•HEMI AZYGOS VEIN
•ACCESORY AZYGOS VEIN
•SYMPATHETIC CHAIN
•VAGUS NERVE
•THROACIC DUCT
•LYMPH NODES

4. CLINICAL CORRELATION
• ANTERO SUPERIOR COMPARTMENT
THYMOMA ( ADULT )
GERM CELL TUMOR
LYMPHOMA
RETROSTERNAL GOITRE
• MIDDLE COMPARTMENT
LYMPHOMA
TUMORS OF BLOODVESSELS
TUMORS OF HEART
• POSTERIOR COMPARTMENT
NEUROGENIC TUMORS ( CHILDREN )
LYMPHOMA

5. CONTENTS
• ANATOMY AND CLINICAL CORRELATION
• APPROACH TO A MEDIASTINAL TUMOR
• OVERVIEW OF DIFFERENT MEDIASTINAL TUMOR

6. APPROACH TO MEDIASTINAL
TUMORS
CLINICAL PRESENTATION
INCIDENTALLY NOTICED
 SYMPTOMS DUE TO
COMPRESSION
SYSTEMIC SYMPTOMS

7. APPROACH TO MEDIASTINAL
TUMORS
DIAGNOSIS
AGE
SYMPTOMS
IMAGING STUDIES
(ANATOMICAL
LOCATION )
THYMOMA - COMMON IN ADULTS
NEUROGENIC TUMORS – COMMON IN CHILDREN
PRESSURE SYMPTOMS
•STRIDOR
•DYSPNEA
•COUGH
•HEMOPTYSIS
•FACE AND UPPER EXTREMITY SWELLING
•CARDIAC TAMPONADE
•PLEURAL EFFUSION
•DYSPHAGIA
•HORNER SYNDROME
SYSTEMIC SYMPTOMS
•FEVER , NIGHT SWEATS , WEIGHT LOSS – LYPHOMA
•DIPLOPIA , PTOSIS , DYSPHAGIA – MYASTHENIA GRAVIS
X-RAY PA AND LATERAL VIEW
CT CHEST WITH CONTRAST
TUMOR MARKERS
ANTI ACETYL CHOLINE ANTIBODIES - MYASTHENIA
GRAVIS
α-FETO PROTEIN AND β-HCG – GERM CELL
TUMORS
MRI - CONFIRM INVASION OR SPINAL CANAL
INVOLVEMENT
FNAC / CORE BIOSPSY

8. APPROACH TO MEDIASTINAL
TUMORS
TREATMENT
 SURGERY –
 CHEMOTHERAPY AND RADIATION
MINIMALLY INVASIVE
• VATS , ROBOTIC
OPEN APPROACH
• MEDIAN STERNOTOMY
• THOROCOTOMY

9. CONTENTS
• ANATOMY AND CLINICAL CORRELATION
• APPROACH TO A MEDIASTINAL TUMOR
• OVERVIEW OF DIFFERENT MEDIASTINAL TUMOR

10. OVERVIEW OF DIFFERENT
MEDIASTINAL TUMORS
• THYMOMA
• NEUROGENIC TUMORS
• GERM CELL TUMORS
• LYMPHOMA

11. THYMOMA
• SEEN BETWEEN 40 – 60 YRS
• ASSOCIATED WITH PARANEOPLASTIC
SYNDROMES LIKE MYASTHENIA , RED CELL
APLASIA, HYPOGAMMAGLOBLINEMIA, SLE
• 2 STAGINGS – MASAOKA AND WHO

12. Stage I – Completely encapsulated .
Stage II – Capsular invasion.
IIA: Microscopic capsular invasion
IIB: Macroscopic invasion into surrounding fatty
tissue or adherent to but not through the mediastinal
pleura or pericardium
Stage III – Pericardial or lung involvement.
IIIA: Macroscopic invasion into pericardium or lung
without great vessel invasion
IIIB: Macroscopic invasion into pericardium or lung
with great vessel invasion
Stage IV – Disseminated disease.
IVA: Pleural or pericardial dissemination
IVB: Lymphatic or hematogenous metastases

13. TREATMENT :
STAGE 1 AND 2 – COMPLETE RESECTION
STAGE 3 AND 4 – COMPLETE RESECTION +
POST OP RADIATION
POST OP CHEMOTHERAPY – CISPLATIN,
DOXORUBICIN, CYCLOPHOSPHAMIDE
IN UNRESECTABLE TUMOR – PRE OP
CHEMOTHERAPY [OR] RADIOTHERAPY IS DONE .

14. OVERVIEW OF DIFFERENT
MEDIASTINAL TUMORS
• THYMOMA
• NEUROGENIC TUMORS
• GERM CELL TUMORS
• LYMPHOMA

15. NEUROGENIC TUMORS
• ORIGIN
SYMPATHETIC GANGLIA :–
GANGLIOMA
GANGLIO-NEUROBLASTOMA
NEUROBLASTOMA
NERVE SHEATH :–
NEUROLEMOMA(SCHWANOMA)
NEUROFIBROMA
NEUROSARCOMA
PARAGANGLION CELLS :-
PHEOCHROMOCYTOMA
NEUROBLASTOMA
• CHILDHOOD TUMOR
• COMMONLY SEEN IN ADRENAL MEDULLA
OTHER SITE – SYMPATHETIC CHAIN
• ARISE FROM NEUROBLASTIC CELLS
• C/F – MASS IN LOIN OR CHEST (PRESSURE SYMPTOM)
OTHER MANIFESTATIONS - RACOON EYE SIGN ,
OPSOMYOCLONUS SYNDROME , HYPERTENSION
, FLUSHING , DIARRHOEA (VIP)
• INVESTIGATION – CT OR MRI , VANILYL
MANDELIC ACID (VMA ) , HOMOVANILIC ACID
(HVA) , MIBG( META IODO BEZYL GUANIDINE)
SCAN , BONE MARROW BIOPSY

16. GRADING OF NEUROBLASTOMA
BASED ON AGE , EXTENT OF DISEASE , HISTOLOGY ,
N-MYC ONCOGENE
LOW RISK 90% - SURGICAL EXCISION
INTERMEDIATE RISK 70 % – EXCISION AND
RADIOTHERAPY
HIGH RISK 30 % – DEBULKING , RADIATION AND
CHEMOTHERAPY (CISPLATIN , DOXORUBICIN ,
CYCLOPHOSPHAMIDE ) AND SECOND LOOK
SURGERY

17. NEUROGENIC TUMORS
• ORIGIN
SYMPATHETIC GANGLIA :–
GANGLIOMA
GANGLIO-NEUROBLASTOMA
NEUROBLASTOMA
NERVE SHEATH :–
NEUROLEMOMA(SCHWANOMA)
NEUROFIBROMA
NEUROSARCOMA
PARAGANGLION CELLS :-
PHEOCHROMOCYTOMA
PHEOCHROMOCYTOMA
• TUMOR ARISES FROM CHROMAFFIN CELLS
• SEEN COMMONLY IN ADRENAL MEDULLA
EXTRA ADRENAL ( PARAGANGLIONS )
• THESE TUMOR SECRETES NORADRENALINE AND
ADRENALINE
• RULE OF 10’S :– 10% - MALIGNANT ,
EXTRAADRENAL , BILATREAL , FAMILIAL , MULTIPLE
, NON HYPERTENSIVE
• CLINICAL FEATURES – HEADACHE , PALPITATION ,
FLUSHING , WEAKNESS , HYPERTENSION ,
• ASSOSIATED WITH MEN 2 , VHL , NF TYPE 1 .

18. • INVESTIGATION –
24 HR URINE OR BLOOD SAMPLE - METANEPHRINE &
NORMETANEPHRINE
MRI FOR LOCALISATION
MIBG SCAN
• TREATMENT :–
INTIALLY α- BLOCKER (PHENOXYLBENZAMINE) IS GIVEN
FOR 10 DAYS
THEN START β – BLOCKERS
SURGICAL EXCISION OF TUMOR IS DONE .
MALIGNANT PHEOCHROMOCYTOMA – SURGERY + I-131 MIBG
+ POST OP CHEMOTHERAPY - MITOTANE +
CYCLOPHOSPHAMIDE , VINCRISTINE , DACARBAZINE .

19. NEUROGENIC TUMORS
• ORIGIN
SYMPATHETIC GANGLIA :–
GANGLIOMA
GANGLIO-NEUROBLASTOMA
NEUROBLASTOMA
NERVE SHEATH :–
NEUROLEMOMA(SCHWANOMA)
NEUROFIBROMA
NEUROSARCOMA
PARAGANGLION CELLS :-
PHEOCHROMOCYTOMA
NEUROFIBROMA
•ARISE FROM SCHWANN CELLS AND CONNECTIVE TISSUES
•TYPES – CUTANEOUS – SMALL , HARD , MULTIPLE NODULES
PLEXIFORM – LARGE , HARD MASS
NON TENDER , PARAESTHESIA ,MOVE PERPENDICULAR TO THE NERVE
•COMMONLY ASSOCIATED WITH NEUROFIBROMATOSIS
TYPE 1 – CHROMOSOME 17 MUTATION , NF-1 GENE .
OTHER FEATURES – AXILLARY FRECKLES , LISCH NODULES,
CAFÉ AU LAIT SPOT .
INVESTIGATION – CT/MRI , SLIT LAMP , MOLECULAR
TESTING .
TREATMENT – SURGICAL EXCISION

20. NEUROGENIC TUMORS
• ORIGIN
SYMPATHETIC GANGLIA :–
GANGLIOMA
GANGLIO-NEUROBLASTOMA
NEUROBLASTOMA
NERVE SHEATH :–
NEUROLEMOMA(SCHWANOMA)
NEUROFIBROMA
NEUROSARCOMA
PARAGANGLION CELLS :-
PHEOCHROMOCYTOMA
SCHWANNOMA
•ARISE FROM SCHWANN CELLS , BENIGN TUMORS
•CAN OCCUR AT ANY SITE
•ASSOCIATED WITH NEUROFIBROMATOSIS TYPE - 2
CAUSING ACOUSTIC NEUROMA .
•C/F – HEARING LOSS , PARAESTHESIA , SOMETIMES
TENDER .
• INVESTIGATION – CT/MRI , AUDIOMETRY .
• TREATMENT – SURGICAL EXCISION

21. NEUROGENIC TUMORS
• ORIGIN
SYMPATHETIC GANGLIA :–
GANGLIOMA
GANGLIO-NEUROBLASTOMA
NEUROBLASTOMA
NERVE SHEATH :–
NEUROLEMOMA(SCHWANOMA)
NEUROFIBROMA
NEUROSARCOMA
PARAGANGLION CELLS :-
PHEOCHROMOCYTOMA

22. OVERVIEW OF DIFFERENT
MEDIASTINAL TUMORS
• THYMOMA
• NEUROGENIC TUMORS
• GERM CELL TUMORS
• LYMPHOMA

23. OVERVIEW OF DIFFERENT
MEDIASTINAL TUMORS
• THYMOMA
• NEUROGENIC TUMORS
• GERM CELL TUMORS
• LYMPHOMA
• CYSTS
GERM CELL TUMORS
• DUE TO FAILURE OF MIGRATION OF GERM CELLS
•GERM CELL TUMORS
•TERATOMA IS THE COMMONEST IN MEDIASTINUM
•C/F – PRESSURE SYMPTOMS
•INVESTIGATION – CT / MRI , X-RAY
•TREATMENT – SURGICAL EXCISION
SEMINOMATOUS TUMOR – RADIOSENSITIVE AND
CHEMOSENSITIVE
NON SEMINOMATOUS – CHEMOSENSITIVE
CHEMOTHERAPY – BEP (BLEOMYCIN , ETOPOSIDE , CISPLATIN)
SEMINOMATOUS
NON- SEMINOMATOUS

24. OVERVIEW OF DIFFERENT
MEDIASTINAL TUMORS
• THYMOMA
• NEUROGENIC TUMORS
• GERM CELL TUMORS
• LYMPHOMA

25. OVERVIEW OF DIFFERENT
MEDIASTINAL TUMORS
• THYMOMA
• NEUROGENIC TUMORS
• GERM CELL TUMORS
• LYMPHOMA
•LYMPHOMA
•2 TYPES – HODGKIN’S AND NON-HODGKIN’S
•SITE :–
HODGKIN’S - MAINLY CERVICAL
OTHER SITE – MEDIASTINUM , AXILLARY , INGUINAL
NON- HODGKIN’S – WALDEYER’S RING , EPITROCHLEAR ,
ABDOMINAL ( MALT )
• C/F – PRESSURE SYMPTOMS , FEVER , WEIGHT LOSS ,
NIGHT SWEATS, ANAEMIA , BONE PAIN .
• INVESTIGATION – X-RAY , CT
•TREATMENT –
RADIOTHERAPY
CHEMOTHERAPY – MOPP ( MUSTINE
,ONCOVINE {VINCRISTINE} , PROCARBAZINE, PREDNISOLONE)
ABVD - ADRIAMYCIN , BLEOMYCIN , VINBLASTINE
DACARBAZINE

26. OVERVIEW OF DIFFERENT
MEDIASTINAL TUMORS
• THYMOMA
• NEUROGENIC TUMORS
• GERM CELL TUMORS
• LYMPHOMA

27. MEDIASTINAL CYSTS
• PERICARDIAL CYST
• BRONCHOGENIC CYST
• ENTERIC CYST
• THYMIC CYST