Mediastinal Tumors

The mediastinum is the area bounded by the sternum, spine, neck, lungs, and diaphragm. It contains the heart, large vessels (aorta, vena cava, and pulmonary arteries and veins), trachea, thymus, some lymph nodes, and the esophagus, among other vital structures.

Mediastinal tumors are rare and develop from abnormal growth of benign or cancerous cells at any point in the mediastinum (anterior, middle, or posterior).

Given that the mediastinum is a large region containing various organs, mediastinal tumors can be of different types depending on their location.

In the anterior mediastinum, the following can develop:

• Thymoma (associated with Myasthenia Gravis) and Thymic Carcinoma: These are the most common mediastinal tumors. They originate in the thymus. Thymomas tend to grow slowly, while thymic carcinoma is more aggressive and spreads more rapidly.
• Thymic cysts: Benign sac-like formations filled with fluid.
• Thymic hyperplasias.
• Thyroid masses: Often benign, such as a goiter.
• Lymphomas: Mediastinal B-cell lymphoma or Hodgkin's lymphoma with nodular sclerosis.
• Germ cell cancer: Can be benign, like teratomas, or malignant (seminomas are the most common).
• Lip sarcoma.
• Fibrosarcoma.

In the middle mediastinum, the following can develop:

• Pericardial cyst: Benign growth of the membrane covering the heart, typically filled with fluid.
• Enteric cyst.
• Bronchogenic cyst: Benign cysts typically filled with fluid or mucus.
• Esophageal pathology: Can be benign, such as achalasia, esophageal diverticulum, or hiatal hernia, but can also be malignant, like esophageal cancer.
• Mediastinal lymphadenopathies: Most frequently associated with lymphoma, sarcoidosis, or metastasis.
• Tracheal neoplasms: Can be benign or malignant.
• Vascular diseases: Most commonly aneurysms or dissections.

In the posterior mediastinum, the following can develop:

• Neurogenic tumors: Such as schwannomas, neuroblastomas, ganglioneuroblastomas, or ganglioneuromas. These are the most common type of tumor in this location and are usually benign.
• Meningoceles.
• Mediastinal lymphadenopathies.
• Neuroenteric cysts.
• Spinal cord tumors.

Symptoms

Mediastinal tumors are often asymptomatic or show signs that are easily confused with other more common conditions. They are most commonly discovered incidentally after a chest X-ray. The most characteristic symptoms of these tumors are due to pressure on nearby structures:

• Chest pain
• Cough, sometimes with blood-streaked sputum
• Difficulty breathing and/or swallowing
• Hoarseness
• Fever
• Chills
• Cold sweats
• Weight loss

Causes

The main causes of mediastinal tumors are:

• Personal history of other types of cancer
• Smoking: Primarily affects the lungs, blood vessels, and heart
• Alcoholism: Increases the likelihood of tumors in the esophagus
• Exposure to chemical pollutants

Risk Factors

Some factors that increase the risk of developing a mediastinal tumor include:

• Male sex
• Over 40 years of age
• Family history of mediastinal tumors
• Smoking, alcoholism, or continuous exposure to chemical pollutants

Complications

The main complications arise from the local growth of the masses that compress adjacent structures, causing symptoms. In addition, malignant mediastinal tumors can present distant complications when metastasizing.

Prevention

There is no known way to prevent the occurrence of mediastinal tumors. However, it is recommended to avoid alcohol and tobacco consumption and to consult a specialist if symptoms such as those previously described appear.

Which doctor treats mediastinal tumors?

The management of mediastinal tumors usually involves thoracic surgeons, neurosurgeons, esophagogastric surgeons, oncologists, radiation oncologists, pulmonologists, among other specialists.