Mediastinal tumor

Causes

The mediastinum is the part of the chest that lies between the sternum and the spinal column, and between the lungs. This area contains the heart, large blood vessels, windpipe (trachea), thymus gland, esophagus, and connective tissues. The mediastinum is divided into three sections:

• Anterior (front)
• Middle
• Posterior (back)

Mediastinal tumors are rare.

The most common location for tumors in the mediastinum depends on the age of the patient. In children, tumors are more common in the posterior mediastinum. These tumors often begin in the nerves and are non-cancerous (benign).

Most mediastinal tumors in adults occur in the anterior mediastinum and are usually cancerous (malignant) lymphomas or thymomas. These tumors are most common in people ages 30 - 50.

Symptoms

Almost half of mediastinal tumors cause no symptoms and are found on a chest x-ray performed for another reason. Symptoms that do occur are due to pressure on (compression of) local structures and may include:

• Chest pain
• Chills
• Cough
• Coughing up blood (hemoptysis)
• Fever
• Hoarseness
• Night sweats
• Shortness of breath

Exams and Tests

A medical history and physical examination may show:

• Fever
• High-pitched breathing sound (stridor)
• Swollen or tender lymph nodes (lymphadenopathy)
• Unintentional weight loss
• Wheezing

Further testing may include:

• Chest x-ray
• CT-guided needle biopsy
• CT scan of the chest
• Mediastinoscopy with biopsy
• MRI of the chest

Treatment

Treatment for mediastinal tumors depends on the type of tumor and your symptoms.

• Surgery is used to treat thymic cancers. It may be followed by radiation or chemotherapy, depending on the stage of the tumor and the success of the surgery.
• Germ cell tumors are usually treated with chemotherapy.
• For lymphomas, chemotherapy followed by radiation is the treatment of choice.
• Surgery is the main treatment for neurogenic tumors of the posterior mediastinum.

Outlook (Prognosis)

The outcome depends on the type of tumor. Different tumors respond differently to chemotherapy and radiation.

Possible Complications

Complications of mediastinal tumors include:

• Spinal cord compression
• Spread to nearby structures such as the heart, lining around the heart (pericardium), and great vessels (aorta and vena cava)

Radiation, surgery, and chemotherapy can all have serious complications.

When to Contact a Medical Professional

Call your health care provider if you notice symptoms of a mediastinal tumor.

Alternative Names

Thymoma - mediastinal; Lymphoma - mediastinal

References

McCool FD. Diseases of the diaphragm, chest wall, pleura,and mediastinum. In Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed.Philadelphia, PA: Saunders Elsevier; 2011:chap 99.

Update Date: 6/5/2012

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.