Abstract
BackgroundThe fundamental treatment for patients with pediatric malignant mediastinal tumors is chemotherapy. Therefore, accurate diagnosis is essential for selecting the appropriate chemotherapeutic regimen. However, malignant mediastinal tumors occasionally cause respiratory distress, and biopsies under general anesthesia are dangerous for such patients as invasive mechanical ventilation can aggravate airway obstruction caused by mass effect. In this study, we reviewed our 10-year diagnostic experience to evaluate the efficacy of our practices and confirm a safe diagnostic protocol for future patients.MethodsWe retrospectively reviewed medical records of children with malignant mediastinal tumors diagnosed at Nagoya University Hospital from 2007 to 2018 who demonstrated respiratory distress. Respiratory distress included dyspnea, massive pleural effusion, wheezing, and hypoxemia owing to tumors. Data on sex, age at onset, primary symptoms, location of tumor, management strategy (especially the method of diagnosis and definitive diagnosis), clinical course, prognosis during the acute phase (within 3 months from the onset of respiratory symptoms), and long-term outcome were collected.ResultsTwelve pediatric patients met the review criteria. There were seven anterior mediastinal tumors and five posterior mediastinal tumors. All anterior mediastinal tumors were diagnosed via bone marrow smear, thoracentesis, or core needle biopsy while maintaining spontaneous breathing. Regarding posterior tumors, two patients were diagnosed via a core needle biopsy and lymph node excisional biopsy under spontaneous breathing. Two cases were initially diagnosed solely using tumor markers. One patient with severe tracheal compression underwent tumor resection with extracorporeal membrane oxygenation stand-by. No patient died of diagnostic procedure-related complications.ConclusionsIn 11 of the 12 cases reviewed, safe and accurate tumor diagnosis was accomplished without general anesthesia. A diagnostic strategy without general anesthesia considering the tumor location proved to be useful.
Highlights
The fundamental treatment for patients with pediatric malignant mediastinal tumors is chemotherapy
In patients with respiratory distress whose bronchus is compressed by a mediastinal tumor, respiratory failure is likely to occur, especially when muscle-relaxant drugs are used for general anesthesia or mechanical ventilation [1]
The remaining patient whose trachea was severely compressed by the tumor, received chemotherapy and was diagnosed by core needle biopsy under local anesthesia while receiving chemotherapy (Fig. 2)
Summary
The fundamental treatment for patients with pediatric malignant mediastinal tumors is chemotherapy. Accurate diagnosis is essential for selecting the appropriate chemotherapeutic regimen. Malignant mediastinal tumors occasionally cause respiratory distress, and biopsies under general anesthesia are dangerous for such patients as invasive mechanical ventilation can aggravate airway obstruction caused by mass effect. The primary treatment for these pediatric malignant mediastinal tumors is chemotherapy. An accurate diagnosis is indispensable for selecting the appropriate chemotherapeutic regimen. In patients with respiratory distress whose bronchus is compressed by a mediastinal tumor, respiratory failure is likely to occur, especially when muscle-relaxant drugs are used for general anesthesia or mechanical ventilation [1]. Avoiding tumor biopsies for mediastinal tumors under general anesthesia has been recommended; the use of alternative diagnostic methods has been advocated [2]
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