Çocukluk Çağı Mediasten Kitlelerine Yaklaşım

Yıl 2016, Cilt: 14 Sayı: 1, 30 - 36, 01.06.2016

Salih Güler Metin Demirkaya , Betül Sevinir

https://doi.org/10.4274/jcp.81905

Öz

Çocukluk çağında torakal kitlelerin önemli bir kısmı mediastende görülür. Mediastende farklı dokulardan köken alan kitleleri daha kolay tanımlamak için mediasten üst ve alt; alt mediasten de ön, orta ve arka mediasten olarak farklı bölümlere ayrılır. Mediasten kitleleri malign veya non-malign olabilir. Kitlelerin büyüklüklerine ve bulunduğu yere göre belirtileri değişebilir. Ön mediastendeki kitleler daha çok hava yollarına ve ana damarlara yapabileceği basılar, arka mediastendeki kitleler de olası bir intramedüller uzanım veya sinir köklerine yapabileceği basılar nedeniyle önem taşımaktadır. Kitlenin büyüklüğüne ve basısına bağlı olarak gelişen belirti ve bulgulara göre acil tedavi gerekebilir. Tanı için öykü ve fizik muayene önemli olmakla birlikte görüntüleme yöntemleri ve laboratuvar tetkikleri yardımcı öğelerdir. Kesin tanı için çoğu zaman histopatolojik değerlendirme gereklidir

Anahtar Kelimeler

Çocukluk çağı, mediasten kitleleri, mediasten bölümleri

Approach to Childhood Mediastinal Mass

Öz

A significant portion of the thoracic masses in childhood are seen in the mediasten. For practical identification of tumors that originate from different tissues, the mediasten is divided into two parts as superior and inferior. The inferior part is subdivided into three portions as anterior, middle and posterior. Mediastinal masses may be malignant or non-malignant. The symptoms vary according to the size and location of the mass. Anterior mediastinal masses are important because of the possibility to press the airways and great arteries. On the other hand, posterior mediastinal masses are also important because of the possibility to extend into intramedullary area and press to nerve roots. According to the symptoms and signs that occur depending on the size and pressure of the mass, immediate treatment may be required. While history and physical examination are important for diagnosis, imaging and laboratory tests are also helpful. Histopathological evaluation is often required for definitive diagnosis

Anahtar Kelimeler

Childhood, mediastinal mass, parts of the mediastinum

Kaynakça

• 1. Lerman J. Anterior mediastinal masses in children. Semin Anesthesia in Perioperative Med Pain 2007;26:133-40.
• 2. Kebudi R. Mediasten kitleleri. Pediatrik Onkoloji. İçinde: Özkan A (ed). Birinci baskı. İstanbul: Nobel Tıp Kitabevleri; 2009:141- 4.
• 3. Mullen B, Richardson JD. Primary anterior mediastinal tumours in children and adults. Ann Thorac Surg 1986;42:338-45.
• 4. Hasdıraz L. Çocukluk çağının mediastinal tümör ve kistleri. Toraks Cerrahi Bülteni 2011;2:136-46.
• 5. Tekinbaş C. Mediasten kitlelerinde klinik ve genel değerlendirme. Toraks Cerrahi Bülteni 2010;1:199-202.
• 6. Thomas W. Shields. Overview of primary mediastinal tumors and cysts. In: Shields TW, LoCicero J, Ponn RB, Rusch VW (eds). General Thoracic Surgery. 6th edition. Philadelphia: Lippincott Williams and Wilkins; 2005:2489-93.
• 7. Sabiston DC, Spencer FC. Surgery of the Chest. 5th edition. WB Saunders Philadelphia; 1990;498-533.
• 8. Kern JA, Daniel TM, Tribble CG, Silen ML, Rodgers BM. Thoracoscopic diagnosis and treatment of mediastinal masses. Ann Thorac Surg 1993;56:92-6.
• 9. Davis RD Jr, Oldham HN Jr, Sabiston DC Jr. Primary cysts and neoplasm of the mediasten: recent changes in clinical presentation, methods of diagnosis, management and results. Ann Thorac Surg 1987;44:229-237.
• 10. Davids RD, Oldham HN, Sabiston DC. The Mediasten. In: Sabiston&Spencer Surgery of the Chest. 6th edition. Philadelphia: WB Saunders Co; 1996:576-611.
• 11. Bacha EA, Chapelier AR, Macchiarini P, Fadel E, Dartevelle PG. Surgery for invasive primary mediastinal tumors. Ann Thorac Surg 1998;66:234-9.
• 12. Sancak B, Cumhur M. Mediastinum. Sancak B, Cumhur M (eds). Fonksiyonel Anatomi, Baş Boyun ve İç Organlar. İkinci baskı. Ankara: Metu Press; 2002:139-40.
• 13. Kebudi R, Ayan İ. Çocukluk çağı kanserlerinde tanısal yaklaşım. İstanbul: 2003:19-21.
• 14. Williams HJ, Alton HM. Imaging of paediatric mediastinal abnormalities. Paediatr Respir Rev 2003;4:55-66.
• 15. Meza MP, Benson M, Slovis TL. Imaging of mediastinal masses in children. Radiol Clin North Am 1993;31:583-604.
• 16. Merten DF. Diagnostic imaging of mediastinal masses in children. Am J Roentgenol 1992;158:825-32.
• 17. Kennebeck SS. Tumors of the Mediasten. Clin Ped Emerg Med 2005;6:156-64.
• 18. Yalçın B, Demir HA, Çiftçi AO, Orhan D, Varan A, Akyüz C, et al. Thymomas in childhood: 11 cases from a single institution. J Pediatr Hematol Oncol 2012;34:601-5.
• 19. Sills RH. Practical algorithms in pediatric hematology and oncology. Basel, Karger 2003:76-7.
• 20. McCarville MB. Malignant pulmonary and mediastinal tumors in children: differential diagnoses. Cancer imaging 2010;10:35-41.
• 21. Shamberger RC. Preanesthetic evaluation of children with anterior mediastinal masses. Semin Pediatr Surg 1999;8:61-8.
• 22. Lam JC, Chui CH, Jacobsen AS, Tan AM, Joseph VT. When is a mediastinal mass critical in a child? An analysis of 29 patients. Pediatr Surg Int 2004;20:180-4.
• 23. Perger L, Lee EY, Shamberger R C. Management of children and adolescents with a critical airway due to compression by an anterior mediastinal mass. J Pediatr Surg 2008;43:1990-7.
• 24. Jaggers J. Balsara K. Mediastinal masses in children. Semin Thorac Cardiovasc Surg 2004;16:201-8.
• 25. Çiftçi E, Gümüştaş S. Mediasten kitleleride transkutanöz biyopsiler. Toraks Cerrahi Bülteni 2011:2;1-4.
• 26. Morrissey B, Adams H, Gibbs AR, Crane MD. Percutaneous needle biopsy of the mediastinum: review of 94 procedures. Thorax 1993;48:632-7.
• 27. de Farias AP, Deheinzelin D, Younes RN, Chojniak R. Computed tomography-guided biopsy of mediastinal lesions: fine versus cutting needle. Rev Hosp Clin Fac Med Sao Paulo 2003;58:69- 74.
• 28. Protopapas Z, Westcott JL. Transthoracic hilar and mediastinal biopsy. Radiol Clin North Am 2000;38:281-9.
• 29. Van Sonnenberg E, Casola G, Ho M, Neff CC, Varney RR, Wittich GR, et al. Difficult toracic lesions: CT-guided biopsy experience in 150 cases. Radiology 1988;167:457-61.
• 30. Aström KG, Ahlström KH, Magnusson A. CT-guided transternal core biopsy of anterior mediastinal masses. Radiology 1996;199:564-7.
• 31. Yalçın B, Demir HA, Tanyel FC, Akçören Z, Varan A, Akyüz C, et al. Mediastinal germ cell tumors in childhood. Pediatr Hematol Oncol 2012;29:633-42.