Malignant Mediastinal Tumors Research Articles

Characteristics of malignant mediastinal tumours presenting in tertiary care center in India and the problems the oncologists have faced over time

Mediastinal neoplasms often present a diagnostic and therapeutic challenge for treating oncologists. Significant advances in the evaluation and diagnosis of these lesions have occurred in recent times. Multimodality treatment has contributed to improved survival for some malignant mediastinal tumor histology, however the overall prognosis remains dismal. This is a review of all the mediastinal tumors received and treated in our Regional Cancer Centre (RCC). The purpose of this analysis was to evaluate distribution of mediastinal tumours, the factors affecting the treatment intent, and understanding the reasons behind the generally known poor prognosis.

Characteristics of malignant mediastinal tumours presenting in tertiary care center in India and the problems the oncologists have faced over time

Characteristics of malignant mediastinal tumours presenting in tertiary care center in India and the problems the oncologists have faced over time

Long survival and recurrence of thymic carcinoma 10 years after resection

Thymic carcinomas are a rare type of malignant mediastinal tumor. Thymic carcinomas have a rapid progression, and recurrence and metastasis usually occur in the early phase after surgical resection. To the best of our knowledge, recurrence more than 10 years after surgical resection has been reported in only one case of neuroendocrine cell carcinoma. We report a case of resected thymic squamous cell carcinoma recurring after 10 years, which indicates that thymic carcinomas require long-term follow-up after surgical resection.

Current status of robot-assisted thoracoscopic surgery for lung cancer.

The robotic surgical system was designed to overcome the drawbacks of conventional endoscopic surgery. Since national health insurance in Japan began covering robotic-assisted thoracoscopic surgery (RATS) for malignant lung and mediastinal tumors in 2018, the number of RATS procedures being performed domestically has increased rapidly. This review evaluates the advantages and disadvantages of RATS for patients with lung cancers, based on an electronic literature search of PubMed. The main advantages of RATS are its ability to achieve excellent lymph-node removal with low morbidity and mortality, and minimal postoperative pain. Conversely, its disadvantages include a long operation time and the need for specialized instruments. However, the learning curve for RATS is reported to be shorter than that for VATS: some studies recommend that a surgeon needs to perform 18-22 robotic operations to attain sufficient skill. RATS for lung cancer is more expensive than VATS and the cost of training is high. Although the main disadvantage of RATS is that it reduces operator's tactile senses, the endoscope, which is directly manipulated by the surgeon at the console, using various magnifications, and 3D HD images on the monitor, may compensate for this. Ultimately, RATS offers better maneuverability, accuracy, and stability over VATS.

Clinical and radiographic characterization of primary seminomas and nonseminomatous germ cell tumors.

Primary malignant mediastinal germ cell tumors (PMMGCTs) including seminomas and nonseminomatous germ cell tumors (NSGCTs) are rare, and sometimes the diagnosis is very difficult. The purpose of this study is to compare the clinical characteristics, biomarkers, and imaging findings of seminomas and NSGCTs and to determine whether these features could help distinguish these two types of PMMGCT. A retrospective study of 24 male patients with histopathologically proven PMMGCT was performed. We collected the information of computed tomography (CT) (the scan area ranged from the apex of lung to the costophrenic angles) and magnetic resonance imaging blood test and histology characteristics of these patients. Twelve of 24 cases were confirmed to be seminomas, whereas the other 12 cases were NSGCTs. Alfa-fetoprotein (AFP) was found to be elevated in all patients with NSGCT, whereas none of the patients with seminomas had elevated AFP level. Beta-human chorionic gonadotropin (β-HCG) level was elevated in all the patients with seminomas (seven/seven), whereas in NSGCT only two of seven patients had elevated β-HCG. Lactate dehydrogenase level was increased in five of the nine patients with seminomas, as well as in the eight patients with NSGCT. CT imaging revealed that 12 masses from the seminoma group were homogeneous, soft tissue opacity and showed minimal contrast enhancement. On the contrary, all 12 NSGCT cases showed cystic and solid masses; on contrast-enhanced CT, heterogeneous enhancement was found on the capsule of the tumor, septum, and solid masses. Seminomas and NSGCT showed different profiles of tumor biomarkers and radiographic features. Evidence from serum test, histopathological analysis, and imaging should be combined to ensure the accurate diagnosis of these two types of PMMGCT.

Intrathoracic extramedullary hematopoiesis as a posterior mediastinal tumor: a case report

Extramedullary hematopoiesis (EMH) is a rare disorder, defined as the appearance of hematopoietic elements outside the bone marrow or peripheral blood. Usually it is diagnosed incidentally and very rarely it presents as a posterior mediastinal mass clinically mimicking with many other benign or malignant mediastinal tumors. Intrathoracic EMH is a rare condition and only very few case reports have been described in patients with chronic myeloproliferative disorders specially myelofibrosis with myeloid metaplasia and spherocytic anemias. The paravertebral area is an uncommon site for EMH, with the possible exception of sporadically reported intrathoracic manifestations. In this study, a 38-year-old male patient was followed for myeloproliferative disease. Tumor-like lesions at the bilateral posterior mediastinum were detected in the patient who applied to our clinic due to fall. Excision was planned with video- assisted thoracoscopic surgery to differentiate from mediastinal tumors, but the mass unblock was removed with posterolateral thoracotomy because of the appearance of the lesion and large size. Histopathologic diagnosis was reported as extramedullary hematopoiesis. Patient was presented because of its rare location.

Primary malignant mediastinal germ cell tumor in childhood

Primary malignant mediastinal germ cell tumor in childhood

Medical image of the week: fast-growing primary malignant mediastinal mixed germ cell tumor

Medical image of the week: fast-growing primary malignant mediastinal mixed germ cell tumor

Role of post-chemotherapy radiation in the management of children and adolescents with primary advanced malignant mediastinal germ cell tumors.

ObjectivePrimary malignant mediastinal germ cell tumors (MMGCTs) are rare in children and adolescents and have a poorer prognosis than their gonadal counterparts. We report a single institutional experience of a 10-year period of primary advanced MMGCTs treated with chemotherapy, followed by radiotherapy in those who had residual mass.MethodsChildren and adolescents with primary advanced MMGCTs between 2005 and 2014 were identified from the Cancer Center, Sun Yat-Sen University. Medical records were reviewed for clinicopathological characteristics, treatments, and outcomes.ResultsTwenty-four children and adolescents with either stage III or IV primary advanced MMGCTs met the inclusion criteria. There were 23 males and one female with a median age of 16 (range 10–18). Seven cases were seminomas (29.2%); four (16.7%) yolk sac tumors (YST); three (12.5%) choriocarcinomas; and ten (41.6%) nonteratomatous combined germ cell tumors (CGCTs). All patients were treated with first-line cisplatin-based chemotherapy regimens (PEB: 19, VIP: 5). Thirteen (54.2%) and Twelve (50%) patients received surgery and radiotherapy, respectively. With a median follow-up of 46.2 months (range 9.6–124.8 months), a total of five (20%) patients died of disease progression; the five-year overall survival (OS) and disease-free survival (DFS) rates were 82.3% and 64.9%, respectively.—Seven patients with seminoma GCTs received post-chemotherapy irradiation were alive with sustained CR (5-year OS and DFS, 100%, respectively). Five patients with NSGCTs were administered irradiation and one relapsed 35 months later and died of metastasis (5-year OS, 100%; 5-year DFS 66.7%). Univariate analysis identified histology and stage were prognostic factors.ConclusionMultimodality treatment approach of chemotherapy followed by radiation consolidation ensured long-term survival in primary advanced MMGCTs. Further research is warranted to improve the prognosis of children with primary advanced MMGCTs.

Assessment of Mediastinal Tumors Using SUVmax and Volumetric Parameters on FDG-PET/CT.

Objective(s):This study aimed to evaluate the role of pretreatment SUVmax and volumetric FDG positron emission tomography (PET) parameters in the differentiation between benign and malignant mediastinal tumors. In addition, we investigated whether pretreatment SUVmax and volumetric FDG-PET parameters could distinguish thymomas from thymic carcinomas, and low-risk from high-risk thymomas.Methods:This study was conducted on 52 patients with mediastinal tumors undergoing FDG-PET/CT. Histological examination indicated that 29 mediastinal tumors were benign, and 23 cases were malignant. To obtain quantitative PET/CT parameters, we determined the maximum standardized uptake value (SUVmax), volumetric parameters, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for primary tumors using SUVmax cut-off value of 2.5. SUVmax, MTV and TLG of benign and malignant tumors were compared using the Mann-Whitney U test. Moreover, receiver-operating curve (ROC) analysis was applied to identify the cut-off values of SUVmax, MTV and TLG for the accurate differentiation of benign and malignant tumors. SUVmax, MTV and TLG were compared between thymomas and thymic carcinomas, as well as low-risk and high-risk thymomas.Results:Mean SUVmax, MTV and TLG of malignant mediastinal tumors were significantly higher compared to benign tumors (P<0.001). Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SUVmax were 78.2%, 86.2%, 82.6%, 81.8%, and 83.3%, respectively. These values were estimated at 82.6%, 96.6%, 90.4%, 95%, and 87.5% for MTV and TLG, respectively. Additionally, optimal cut-off values for the differentiation of benign and malignant mediastinal tumors were determined at 4.2 and 22.3 mL and 79.7 g for SUVmax, MTV and TLG, respectively. Mean SUVmax, MTV and TLG of thymic carcinomas were significantly higher compared to thymomas (P<0.01), while no significant differences were observed in the mean quantitative parameters between low-risk and high-risk thymomas.Conclusion:Although SUVmax, MTV and TLG could not distinguish between low-risk and high-risk thymomas, these parameters might be able to differentiate benign tumors from malignant mediastinal tumors noninvasively. These parameters could be used to distinguish between thymomas and thymic carcinomas as well. Therefore, FDG-PET/CT parameters seem to be accurate indices for the detection of malignant mediastinal tumors.

Primary Malignant Mediastinal Germ Cell Tumors

Primary malignant mediastinal germ cell tumors are the most common extragonadal germ cell tumors in young adults (PMMGCT). We review in our report the clinical features and therapeutic strategies and outcome of three patients diagnosed with PMMGCT at the department of medical oncology at Hassan II University Hospital of Fez, Morocco and we review briefly the existing literature data.

ЭНДОВАСКУЛЯРНАЯ ТАКТИКА ПРИ КЛИНИЧЕСКИ ЗНАЧИМЫХ ТРОМБОЗАХ ВЕРХНЕЙ ПОЛОЙ ВЕНЫ И ВЕН БРАХИОЦЕФАЛЬНОГО РЯДА

Superior vena cava syndrome (SVCS) is a relatively common complication of malignant mediastinal tumors and can cause severe functional impairment. Over the past 20 years, in addition to the conventional management of the disease, interventional treatment of this syndrome has become a viable option for alleviating the symptoms of SVCS. Thus, multidisciplinary care can maximize the effectiveness of treatment for patients with SVCS.

P2.04-044 Mediastinal Neurogenic Tumors: Histopathological Characteristics and Surgical Treatment in a Single-Institutional Experience: Topic: Esophageal Cancer and Other Malignancies

Intrathoracic neurogenic tumors are uncommon and typically originate from the peripheral nerves, paraganglionic nerves, or the autonomic nervous system. They are commonly found in the mediastinum, especially in the posterior mediastinum and have a variety of clinical and histological features. Mediastinal neurogenic tumors in adults are generally benign lesions. We retrospectively reviewed our institutional experience of mediastinal neurogenic tumors from 2010 to 2015. The patients were evaluated according to age, gender and histological characteristics of the tumor. There were 78% males and 22% females diagnosed with mediastinal neurogenic tumors. Mean age was 48.4±12 years. Distribution according to the histopathological diagnosis was: 56% schwannoma, 22% malignant schwannoma, 22% ganglioneuroma. The operative procedure performed in all cases was tumor extirpation through thoracotomy. In 10% of cases, presence of intraspinal growth was encountered (the so-called “dumbbell tumors”), thus hemilaminectomy was performed. There were no operative deaths and minimal morbidity. Mean postoperative stay was 5 days. In this study, the most common mediastinal neurogenic tumor found was schwannoma. Neurogenic tumors arising in the mediastinum are generally of benign nature and mostly found in males. The treatment of choice for malignant and benign mediastinal neurogenic tumors is complete resection for the purposes of avoiding local invasion, facilitating differential histopathological diagnosis and preventing malignant degeneration. The surgical management of the dumbbell tumors differs from others.

Long-term outcomes of pediatric and adolescent mediastinal germ cell tumors: a single pediatric oncology institutional experience.

To evaluate the epidemiologic, demographic, and clinical characteristics, as well as prognostic factors and long-term outcomes of mediastinal germ cell tumors (MGCT) in children. A retrospective study of pediatric patients diagnosed with a primary MGCT between January 1963 and August of 2014 was performed. Twenty-five patients were identified. Six children with teratomas were treated with resection alone (median age 7.8years, range newborn to 15years) and were cured without recurrence or progression. Nineteen children were treated for a malignant MGCT (median age 11.7years, range 7months-18years); 5year overall survival (OS) was 0.39±0.12. For malignant non-seminomatous mediastinal germ cell tumors, platinum-based chemotherapy regimen (OS 0.56 vs 0.14, p=0.03), complete surgical resection with negative margins (OS 0.73 vs 0.11, p=0.03); and localized disease (OS 0.76 vs 0.0, p=0.004) demonstrated a survival advantage. Initial surgical resection is appropriate for teratomas. Localized disease, complete resection, and platinum-based chemotherapy are associated with improved survival in malignant non-seminomatous mediastinal germ cell tumors. Neoadjuvant, platinum-based three drug regimens followed by delayed surgical resection is the appropriate treatment modality for malignant mediastinal germ cell tumors.

Stenting in malignant superior vena cava syndrome review advances: in interventional radiology

Superior vena cava (SVC) syndrome is a clinical syndrome which is caused by obstruction or compression of SVC and characterized by congestion and edema of upper body, upper extremities, and face, dilatation of neck, arm, and chest wall veins, respiratory distress, and cyanosis and the patients may experience cough, dyspnoea, haemoptysis, dysphagia, chest pain, headache, visual disturbance, convulsions and coma [1,2]. SVC syndrome may be caused by indwelling catheters, pacemaker wires or fibrosing mediastinitis [3-5] but 90 – 95% of the cases are caused by lung or mediastinal malignant tumors [6]. In these cases tIndication andhe aim of endovascular stent implantation is palliative and to alleviate the patients’ symptoms. It has been used in stenosis and obstruction of SVC for more than two decades [7,8]. Stent has become widely accepted in the management of malignant SVC obstruction and is now an accepted therapy as treatment of malignant SVC obstruction especially in advanced lung cancer and mediastinal tumours. Stenting in malignant SVC obstruction is increasingly been performed as it offers rapid relief of symptoms and gives the patients a better quality of life during their limited life expectancies due to the malignant disease itself.

Clinicopathological features and management of patients with primary malignant mediastinal germ cell tumor: 10 year’s experience in Peruvian patients.

e13088Background: Primary malignant mediastinal germ cell tumor (PMMGCT) are rare and have poor prognosis with particularly different biology from those of other germ cell tumor. The aim of this study was to evaluate the clinicopathological features, different types of treatment response and survival these patients. Methods: Forty-six patients with PMMGCT who were treated at the Instituto Nacional de Enfermedades Neoplasicas, from 2003 to 2012. Overall survival (OS) curves were estimated using the Kaplan-Meier method and comparisons were done using the log-rank test. A p-value < 0.05 was considered statistically significant. Results: Forty-six men and 2 women with a median age of 23 [range: 3-68] were identified, of whom 17 (35.4%) had pure seminoma, 11 (22.9%) had non-seminomatous, 11 (22.9%) had mixed histology and 9 (18.8%) were not determined of histologic type. Thirty-one (64.6%) had tumor located at mediastinum, 7 (14.6%) had lung metastases and /or effusion and 10 (20.8%) had distant metastases. Th...

Multimodality treatment of primary mediastinal germ cell tumor with growing teratoma syndrome: a case report

Germ cell tumors arise from errors occurring during the migration of embryonic stem cells to the gonads. They constitute 10-15% of malignant mediastinal tumors. Thirty-nine years old male patient was admitted with shortness of breath and gynecomastia. Positron emission tomography / Computed tomography (PET/CT) showed hypermetabolic mediastinal mass in the anterior mediastinum. Serum tumor markers were elevated. Mixed germ cell tumor was diagnosed via transthoracic tru-cut biopsy. After three cycles of systemic cisplatin, etoposide and bleomycin treatment, PET/CT showed a decreased metabolic activity but an increase in the size of mass. Growing teratoma syndrome was diagnosed. The excision of the mass was performed via a median sternotomy. Then autologous stem cell transplantation was performed. Patients was presented as a successful example of a multimodality treatment of a primary mediastinal germ cell tumor with GTS.

Diffusion Weighted Imaging Can Distinguish Benign from Malignant Mediastinal Tumors and Mass Lesions: Comparison with Positron Emission Tomography

Diffusion-weighted magnetic resonance imaging (DWI) makes it possible to detect malignant tumors based on the diffusion of water molecules. It is uncertain whether DWI is more useful than positron emission tomography-computed tomography (PET-CT) for distinguishing benign from malignant mediastinal tumors and mass lesions. Sixteen malignant mediastinal tumors (thymomas 7, thymic cancers 3, malignant lymphomas 3, malignant germ cell tumors 2, and thymic carcinoid 1) and 12 benign mediastinal tumors or mass lesions were assessed in this study. DWI and PET-CT were performed before biopsy or surgery. The apparent diffusion coefficient (ADC) value (1.51±0.46x10(-3) mm2/sec) of malignant mediastinal tumors was significantly lower than that (2.96±0.86x10(-3) mm2/sec) of benign mediastinal tumors and mass lesions (P<0.0001). Maximum standardized uptake value (SUVmax) (11.30±11.22) of malignant mediastinal tumors was significantly higher than that (2.53±3.92) of benign mediastinal tumors and mass lesions (P=0.0159). Using the optimal cutoff value (OCV) 2.21x10(-3) mm2/sec for ADC and 2.93 for SUVmax, the sensitivity (100%) by DWI was not significantly higher than that (93.8%) by PET-CT for malignant mediastinal tumors. The specificity (83.3%) by DWI was not significantly higher than that (66.7%) for benign mediastinal tumors and mass lesions. The accuracy (92.9%) by DWI was not significantly higher than that (82.1%) by PET-CT for mediastinal tumors and mass lesions. There was no significant difference between diagnostic capability of DWI and that of PET-CT for distinguishing mediastinal tumors and mass lesions. DWI is useful in distinguishing benign from malignant mediastinal tumors and mass lesions.

Role of radiotherapy in treating patients with primary malignant mediastinal non-seminomatous germ cell tumor: A 21-year experience at a single institution.

BackgroundThe aim of this study was to investigate the clinical characteristics and outcomes of patients with primary malignant mediastinal non-seminomatous germ cell tumor (MMNSGCT) by comparing the efficacies of different treatment modalities.MethodsThe charts of 62 consecutive patients with MMNSGCT between 1990 and 2010 were reviewed. Analyses included Kaplan-Meier survival and Cox multivariate regression.ResultsThere was sufficient data of 61 patients for inclusion in the study. The median age was 25 years. At diagnosis, 35 patients had tumors located in the mediastinum, 26 had lung and/or distant metastases. At a median follow-up of 47.2 months, 32 patients had died and 43 had developed progressive disease. The one, three, and five-year overall survival (OS) and progression-free survival (PFS) rates were 72.1%, 50.8%, 49.2% and 47.5%, 32.8%, 32.8%, respectively. Patients who received radiotherapy in the primary treatment regimen showed improved five-year OS (68.2% vs. 38.5%, P = 0.043), PFS (45.5% vs. 20.5%, P = 0.023), and local recurrence-free survival (LRFS) (77.3% vs. 38.5%, P = 0.003) compared with those who did not receive radiotherapy. Multivariate analysis revealed that radiotherapy was an independent prognostic factor of five-year OS (hazard ratio [HR] 0.39, P = 0.037), PFS (HR 0.42, P = 0.017), and LRFS (HR 0.31, P = 0.019).ConclusionRadiotherapy in a chemotherapy-based treatment regimen could significantly reduce local recurrence and improve survival of MMNGCT patients.

Management of the primary malignant mediastinal germ cell tumors: experience with 54 patients

BackgroundPrimary malignant mediastinal germ cell tumor (PMMGCT) is rare and sometimes the prognosis of the patients with PMMGCT is not very satisfactory.MethodsA total of 54 patients with PMMGCT in a follow-up from 1990 to 2009. We evaluated the role of the surgical treatment and the effect of multimodality treatment strategy for patients with PMMGCT.ResultsFifty-two patients underwent surgical resections, while the other two patients just received chemoradiotherapy. Among the 52 patients, 28 cases received preoperative adjuvant therapy and 24 cases underwent surgery as initial treatment; 30 cases with complete resections, 18 cases with partial resections and 4 cases with only biopsies. There was no perioperative mortality. Histopathologic results revealed 18 cases of seminomas and 36 cases of nonseminomatous germ cell tumors (NSGCT). The last follow-up showed that 17 patients were alive, including 11 patients with seminoma and 6 patients with NSGCT. The 5-year overall survival rate of patients with seminomas was 87.7%. The 3-year and 5-year overall survival rates of patients with NSGCT were 47.4% and 23.0%, respectively.ConclusionsIt could be concluded that a complete surgical resection of PMMGCT after chemoradiotherapy showed favorable long-term survival. Patients with pure seminomas have a better prognosis compared with that with NSGCT.Virtual slidesThe virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1676987232116837.