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Mediastinal cysts and tumours 

Mediastinal cysts and tumours

Mediastinal cysts and tumours

Malcolm K. Benson

, Robert J.O. Davies

, Helen E. Davies

, and Y.C. Gary. Lee



Investigation—increased usage of (1) PET-CT scanning to evaluate mediastinal masses, (2) endobronchial ultrasound guided transbronchial needle aspiration to assess middle mediastinal lymph nodes.

Thymomas—notes on classification and description of thymic carcinoma (type C thymoma).

Other masses—updated notes on germ cell tumours, Castleman’s disease, and enteric cysts.

Updated on 30 May 2013. The previous version of this content can be found here.
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date: 23 April 2017

Mediastinal masses are most conveniently categorized by their anatomical site in the anterior, middle, or posterior mediastinum. Most present as a radiographic abnormality alone, or in association with symptoms arising from local compression of the numerous mediastinal structures. Nonspecific constitutional symptoms such as fever or weight loss are more likely with malignant tumours such as lymphomas or thymomas.

Anterior mediastinal masses are commonly caused by thymic tumours (including thymic lymphoma), germ-cell tumours, and thyroid masses. Thymomas are often benign, but they can be locally invasive, and can be associated with paraneoplastic phenomena, with myasthenia gravis in 30%.

Middle mediastinal masses—most commonly caused by lymph node enlargement (e.g. secondary to carcinoma, lymphoma, sarcoidosis, tuberculosis, histoplasmosis), bronchogenic carcinomas, and cysts arising from mediastinal structures such as the pericardium, bronchi, and oesophagus. Giant follicular lymph node hyperplasia (Castleman’s disease) is a rare condition that can present with symptoms due to local pressure or systemic symptoms, with some progressing to frank malignancy.

Posterior mediastinal masses—most commonly these are neurogenic tumours; if benign they tend to be asymptomatic, whilst if malignant they cause pressure effects.

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