Clinical approach to childhood mediastinal tumors and management

Abstract

Mediastinal tumours are not uncommon in paediatric population and often pose a diagnostic challenge. They include a variety of entities including developmental, inflammatory, infectious and neoplastic; most are malignant. These lesions can be classified based on imaging according to the specific compartment (anterior, middle and posterior), generating a focused differential diagnosis. This combined with a rational, clinically oriented approach based on patient’s history, focused physical examination, age, gender, symptoms, signs, anatomic localization, imaging characteristics and laboratory investigations including tumor markers paves way to a presumptive diagnosis guiding additional and prudent investigations. For example, a suspicion of lymphoma should be kept in a child presenting with a neck mass and superior vena cava syndrome. Neuroblastoma should be suspected among children younger than 5 years old with a posterior mediastinal mass. Such a structured approach along with histopathology will lead to an exact diagnosis. Surgery remains the mainstay of treatment of most benign and malignant non-lymphoid tumours. For optimal management, a combined modality of treatment incorporating chemotherapy and radiotherapy is often required in malignant tumours and is associated with high survival rates in these patients. In the present article, we review the approach to evaluation of mediastinal masses in childhood from a clinical perspective.

Mediastinal teratoma in children: A case series of misdiagnoses in a high-endemic tuberculosis setting

“…Initially, we thought the mass originated from the nervous system or might have neurogenic involvement. Therefore, before we proceeded with the operation, thoracic spine MRI was conducted to evaluate local tumor spread and identify tumor extension into the spinal canal, which was crucial in determining appropriate surgical planning and management strategies [ 2 , 12 , [15] , [16] , [17] ].…”

“…Mediastinal mass in this location may be caused by neoplasm, pseudomass, congenital, and infection. Moreover, more than three quarters of the mediastinal mass are malignant [ 1 , 2 ]. The term “teratoma” has its etymological roots in the Greek words “terato” and “oncoma,” which translate to “monster” and “swelling,” respectively.…”

Giant mediastinal teratoma in a young infant: a case report

“…In the pediatric population, chest masses are most commonly located in the mediastinum ( 1 ). Giant mediastinal tumors can pose unique challenges for resection such as cardiovascular collapse on induction of anesthesia and injury to surrounding structures that may be compressed, displaced, or invaded by the mass ( 2 ).…”

Resection of a mature giant teratoma with clamshell incision thoracotomy approach: Case report and literature review

“…The most prevalent location of chest masses in children is in the mediastinum. 1 Giant mediastinal tumors can provide unique excision issues, such as circulatory collapse during anesthetic induction and harm to nearby structures that may be crushed, displaced, or infiltrated by the mass. 8 Rather than invading neighboring structures, mature teratomas tend to displace them.…”

“…Infant and early adults can develop mediastinal mass, the most frequent of which are thymomas or teratomas. 1 Teratoma are tumors that arise from one of the three germ layers. Teratomas are tumors that arise from the ectoderm, endoderm, and mesoderm, but they can also occur from a single germ layer.…”