What is Mediastinum, Where Is It?
It is the region within the thoracic cavity, which is bordered by the posterior surface of the sternum in the front, the vertebrae in the back, the lungs on the sides, and contains the heart, great vessels, lymph node stations and nerve structures. Since there are many different tissues in this area, a wide variety of tumors and cysts are seen.
What are Mediastinal Tumors?
The most common tumors are & thymoma and nerve sheath tumors and lymphomas. Apart from these, rare tumors such as germ cell tumors, hamartomas, thymic carcinoid, thymic carcinomas, teratoma, neuroblastomas, sarcoidosis can be seen. In some cases, the thyroid tissue may enlarge and extend towards the mediastinum.
The images below show the MR image of a patient with teratoma in the anterior mediastinum and the teratoma mass that we removed by operation.
Some of the mediastinal tumors are benign and some are malignant. They usually cause complaints by compressing the veins, trachea or nerve structures around them.
The picture below shows the anterior mediastinal tumor that we removed by operation in our 61-year-old female patient.
Thymomas are one of the most common mediastinal tumors.
What are Mediastinal Cysts?
Formations such as bronchogenic cysts, thymic cysts, pericardial cysts, esophageal cysts can be seen.
These fluid-filled formations are usually benign. Since cystic formations do not cause strong pressure, they do not cause significant complaints in patients.
Cystic diseases should be surgically removed almost completely. Tumors, on the other hand, are either surgically removed or treated with chemotherapy and/or radiotherapy, depending on whether they are benign or malignant, their relationship with the surrounding structures, and the general condition of the patient. In some cases, all treatment methods can be used together.
Why is Surgery Necessary in Mediastinal Cyst and Tumor?
Surgery is sometimes required for complete removal of the cyst or tumor, and sometimes for diagnosis. Surgical intervention is necessary for reasons such as eliminating the conditions caused by the tumor or cyst by creating pressure and preventing the spread of a malignant tumor to the body.
What do International Sources recommend?
- Macchiarini P, Ostertag H (February 2004). “Uncommon primary mediastinal tumors”. Lancet Oncol. 5 (2): 107–18. doi:10.1016/S1470-2045(04)01385-3. PMID 14761815.
- Davis RD, Oldham HN, Sabiston DC (September 1987). “Primary cysts and neoplasms of the mediastinum: recent changes in clinical presentation, methods of diagnosis, management, and results”. Ann. thorac. Surg. 44 (3): 229–37. PMID 2820323.
- Kuo TT (2001). “Classification of thymic epithelial neoplasms: a controversial issue coming to an end?”. J. Cell. Mole. Med. 5 (4): 442–8. doi:10.1111/j.1582-4934.2001.tb00182.x. PMID 12067481. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm.: pubmed&issn=1582-1838&date=2001&volume=5&issue=4&spage=442
What are the Surgical Methods in Mediastinal Tumors and Cysts?
One of the following 2 ways can be used in the vast majority of patients, depending on the location of the tumor or cyst, whether it is benign or malignant, the age and general condition of the patient.
1. Open Mediastinal Surgery
Unless it is necessary, this type of operation is not preferred. In this method, either the sternum or the intercostal area is opened
2. Closed Mediastinum Surgery
- The operation performed without opening the thorax is less harmful to the patient, less painful and more comfortable for the patient.
- It is performed with the help of a camera through a single small incision.
- The hospital stay is 1-3 days
- The pain is minimal
- Requires special training and long experience.
What are the Risks of Mediastinal Surgery?
The mediastinum is an important region and operations require significant surgical experience. Depending on whether the patients have additional diseases or not, and the characteristics of the tumor or cyst, different risks may occur. These include bleeding during the operation, damage to the nerves in nerve (neurogenic) tumors, infection, and the need for reoperation. All these situations should be known in advance and the risks should be minimized by taking the necessary precautions.
How Many Days Should I Stay in the Hospital After Mediastinal Surgery?
The average postoperative hospital stay is 3 days.