Primary mediastinal cysts and tumors: 10 year experience

Abstract

Objective: To present the investigations related to the symptoms, surgical techniques, post-operative complications and pathologies of the cases with mediastinal cysts and masses.

Material and Methods: Ninety cases with mediastinal cysts were evaluated retrospectively between 2009-2019. Patients were investigated regarding age, gender, complaints, radiological location of cysts, pre-operative diagnosis, type of surgeries, post-operative complications, removal of drains and pathologies.

Results: Of cases, 39 (43.3%) were men, and 51 (56.7%) were women. Mean age was 44, and 48.9% had no complaints. The most common complaints reported were, in turn, chest pain (41.3%), dispnea (34.8%) and cough (15.2%).Without any differentiation between benign and malignant cases, 74.4, 20 and 5.6% of the cysts were located in anterior, middle and posterior mediastinum, respectively. Preoperative diagnosis was performed by transthoracic or USG tru-cut biopsy in 8.9% of patients. For diagnostic and threapeutic purposes, 61.1%, 21.1% and 10% of patients were operated through thoracotomy, sternotomy and video-assisted thoracic surgery (VATS) respectively, while 7.8% were operated with first thoracotomy and then VATS. The drains were removed approximately on 5th day. The most common post-operative complications were atelectasis and secretion, and mortality rate was found as 2.2%. The post-operative pathologies were benign in 63.3% and malignant in 36.7% of the cases. Frequencies of pathologies were respectively as follows: thymic diseases (45.5%), neurogenic tumors (12.2%), developmental cysts (10%), Hodkgin’s lymphomas (4%) and hydatid cysts (4%).

Conclusion: There is no need for invasive radiological interventions with the mediastinal structures in non-invasive cases for pre-operative diagnosis.Surgery is an effective method in the diagnosis and treatment of patients without invasion to surrounding tissues, and for whom no lymphomas and germ-cell tumors are considered.

Keywords

• Benign
• cyst
• malignant
• mass
• mediastinum

Primer mediastinal kist ve tümörler: 10 yıllık deneyim

Öz

Amaç: Mediastinal kist ve kitle nedeniyle opere edilen olguların semptomları, operasyon yöntemleri, postoperatif komplikasyon ve patolojilerini inceledik.

Gereç ve Yöntemler: 2009-2019 yılları arasında mediastinal kitlesi olan 90 olgu retrospektif olarak incelendi. Hastalar yaş, cinsiyet, şikayet, radyolojik yerleşim yeri, preop. tanı, ameliyat şekli, postoperatif komplikasyonlar, dren çekilme süresi, patoloji yönünden analiz edildi.

Bulgular: Olguların 39'u ( % 43,3 ) erkek, 51'i ( 56,7 ) kadındı. Ortalama yaş 44 idi. Hastaların % 48,9'unde şikayet yoktu. En fazla şikayet sırası ile göğüs ağrısı ( % 41,3 ), dispne ( % 34,8 ), öksürüktü ( % 15,2 ). Benign-malign ayrımı yapmadan olguların %74,4'i ön mediastende, %20'si arka mediastende ve % 5,6'ü orta mediasten yerleşimliydi. Hastaların % 8,9'unda transtorasik veya USG ile tru-cut biopsi yapılarak preoperatif tanı konuldu. Tanı veya tedavi amaçlı hastaların %61,1'ine torakotomi, % 21,1'ine sternotomi, %10'una VATS, %7,8'ine ise VATS ile başlanıp torakotomiye dönülerek opere edildi. Hastaların drenleri ortalama 5.günde çekildi. Postoperatif en fazla olan komplikasyon atelektazi ve sekresyondu. Mortalite %2,2 idi. Olguların postoperatif patolojisi % 63,3'ü benign, %36,7 maligndi. Patoloji en sık sırası ile %45,5 timik hastalıklar, %12,2 norojenik tumorler, %10 gelişimsel kistler, % 4 hodgking lenfoma, %4 hidatik kistti.

Sonuç: Radyolojik olarak mediastinal yapılara invazyon olmayan olgularda preoperatif tanı için invaziv girişimlere gerek yoktur. Lenfoma ve germ hücreli tümor olduğu düşünülmeyen ve etraf dokulara invazyon olmayan hastalarda cerrahi hem tanı hem tedavide etkin bir yöntemdir.

Anahtar Kelimeler

• Benign
• kist
• malign
• kitle
• mediasten

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