Primary mediastinal cysts and tumors: 10 year experience

Yıl 2020, Cilt: 13 Sayı: 3, 629 - 634, 18.09.2020

Tolga Semerkant , Hıdır Esme

https://doi.org/10.31362/patd.645557

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• Date H. Diagnostic strategies for mediastinal tumors and cysts. Thorac Surg Clin. 2009 Feb;19(1):29-35.
• Sharma P. Jha V. Kumar N. Kumar R. Mandal A.Clinicopathological Analysis of Mediastinal Masses: A Mixed Bag of Non-Neoplastic and Neoplastic Etiologies. Turk Patoloji Derg. 2017;33(1):37-46.
• Akshatha Rao Aroor. Rama Prakasha S.. Shubha Seshadri. Teerthanath S.. and Uppoor Raghuraj. A Study of Clinical Characteristicsof Mediastinal Mass. Published online 2014 Feb 3. doi: 10.7860/JCDR/2014/7622.4013
• Juanpere S . Cañete N . Ortuño P . Martinez S . Sanchez G . Bernado L . A diagnostic approach to the mediastinal masses. Insights Imaging. 2013 Feb; 4 (1): 29-52.
• Kubota K. Yamada S. Kondo T. Yamada K. Fukuda H. Fujiwara T. Ito M. Ido T. Br J Cancer.PET imaging of primary mediastinal tumours. Br J Cancer. 1996 Apr;73(7):882-6.
• Iguchi T. Hiraki T. Matsui Y. Fujiwara H. Sakurai J. Masaoka Y. Uka M. Tanaka T. Gobara H. Kanazawa S. CT fluoroscopy-guided core needle biopsy of anterior mediastinal masses. Diagn Interv Imaging. 2018 Feb;99(2):91-97.
• Pun YW. Moreno Balsalobre R. Prieto Vicente J. Fernández Fau L. Multicenter experience of video-assisted thoracic surgery to treat mediastinal cysts and tumors.Article in Spanish Arch Bronconeumol. 2002 Sep;38(9):410-4.
• Yoshiki Kozu. Kenji Suzuki. Shiaki Oh. Takeshi Matsunaga. Yukio Tsushima. Kazuya Takamochi. Single Institutional Experience with Primary Mediastinal Cysts: Clinicopathological Study of 108 Resected Cases. Ann Thorac Cardiovasc Surg 2014; 20: 365–369
• Ramakant Dixit. Narender Singh Shah. and Sabarigiri Vasan Harish.Diagnostic evaluation of mediastinal lesions: Analysis of 144 cases. Lung India. 2017 Jul-Aug;34(4):341-348. Bastos P. Magalhães A. Fernandes G. Cruz MR. Saleiro S. Gonçalves L. Piñon M. Primary cysts and tumors of the mediastinum. Rev Port Pneumol. 2007;13(5):659-73.
• Bastos P. Magalhães A. Fernandes G. Cruz MR. Saleiro S. Gonçalves L. Piñon M. Primary cysts and tumors of the mediastinum. Rev Port Pneumol. 2007;13(5):659-73.
• Biswajit Dubashi. Sanju Cyriac. and Sagar Gnana Tenali. Clinicopathological analysis and outcome of primary mediastinal malignancies — A report of 91 cases from a single institute. Ann Thorac Med. 2009 Jul-Sep; 4(3): 140–142.
• Temes R. Chavez T. Mapel D. Ketai L. Crowell R. Key C. Follis F. Pett S. Wernly J. Primary mediastinal malignancies: findings in 219 patients. West J Med. 1999 Mar;170(3):161-6.
• Bacha EA. Chapelier AR. Macchiarini P. Fadel E. Dartevelle PG. Surgery for invasive primary mediastinal tumors. Ann Thorac Surg. 1998 Jul;66(1):234-9