Benign tumors of the mediastinum. Mediastinal tumor - symptoms in adults, classification, treatment Space-occupying lesion of the upper anterior mediastinum

What are malignant neoplasms of the anterior mediastinum?

Malignant neoplasms of the anterior mediastinum in the structure of all oncological diseases account for 3-7%. More often malignant neoplasms anterior mediastinum are detected in persons 20-40 years old, i.e., in the most socially active part of the population.

Mediastinum called the part of the thoracic cavity bounded in front by the sternum, partly by the costal cartilages and retrosternal fascia, and behind by the anterior surface thoracic the spine, the necks of the ribs and the prevertebral fascia, on the sides - the layers of the mediastinal pleura. The mediastinum is limited below by the diaphragm, and above by a conventional horizontal plane drawn through the upper edge of the manubrium of the sternum.

The most convenient scheme for dividing the mediastinum was proposed in 1938 by Twining - two horizontal (above and below the roots of the lungs) and two vertical planes(in front and behind the roots of the lungs). In the mediastinum, therefore, three sections (anterior, middle and posterior) and three floors (upper, middle and lower) can be distinguished.

In the anterior section of the superior mediastinum there are: the thymus gland, the upper section of the superior vena cava, the brachiocephalic veins, the aortic arch and its branches, the brachiocephalic trunk, the left common carotid artery, the left subclavian artery.

In the posterior part of the upper mediastinum there are: the esophagus, the thoracic lymphatic duct, the trunks of the sympathetic nerves, the vagus nerves, nerve plexuses organs and vessels of the chest cavity, fascia and cellular spaces.

In the anterior mediastinum there are: fiber, spurs of the intrathoracic fascia, the leaves of which contain the internal mammary vessels, retrosternal lymph nodes, and anterior mediastinal nodes.

In the middle section of the mediastinum there are: the pericardium with the heart enclosed in it and the intrapericardial sections of large vessels, the tracheal bifurcation and the main bronchi, pulmonary arteries and veins, phrenic nerves with accompanying phrenic-pericardial vessels, fascial-cellular formations, lymph nodes.

In the posterior part of the mediastinum there are: the descending aorta, azygos and semi-gypsy veins, trunks of sympathetic nerves, vagus nerves, esophagus, thoracic lymphatic duct, lymph nodes, tissue with spurs of the intrathoracic fascia surrounding the organs of the mediastinum.

According to the departments and floors of the mediastinum, certain preferential localizations of most of its neoplasms can be noted. Thus, it has been noticed, for example, that intrathoracic goiter is often located in the upper floor of the mediastinum, especially in its anterior section. Thymomas are found, as a rule, in the middle anterior mediastinum, pericardial cysts and lipomas - in the lower anterior. The upper floor of the middle mediastinum is the most common location of teratodermoids. In the middle floor of the middle part of the mediastinum, bronchogenic cysts are most often found, while gastroenterogenic cysts are detected in the lower floor of the middle and posterior parts. The most common neoplasms of the posterior mediastinum along its entire length are neurogenic tumors.

Pathogenesis (what happens?) during malignant neoplasms of the anterior mediastinum

Malignant neoplasms of the mediastinum originate from heterogeneous tissues and are united by only one anatomical border. These include not only true tumors, but also cysts and tumor-like formations of different localization, origin and course. All mediastinal neoplasms according to their source of origin can be divided into the following groups:
1. Primary malignant neoplasms of the mediastinum.
2. Secondary malignant tumors of the mediastinum (metastases of malignant tumors of organs located outside the mediastinum to the lymph nodes of the mediastinum).
3. Malignant tumors of the mediastinal organs (esophagus, trachea, pericardium, thoracic lymphatic duct).
4. Malignant tumors from tissues limiting the mediastinum (pleura, sternum, diaphragm).

Symptoms of malignant neoplasms of the anterior mediastinum

Malignant neoplasms of the mediastinum are found mainly in young and middle age (20 - 40 years), equally often in both men and women. During the course of the disease with malignant neoplasms of the mediastinum, an asymptomatic period and a period of pronounced clinical manifestations can be distinguished. Duration asymptomatic period depends on the location and size of the malignant neoplasm, growth rate, relationship with organs and formations of the mediastinum. Very common mediastinal neoplasms long time are asymptomatic and are accidentally discovered during a preventive X-ray examination chest.

Clinical signs of malignant neoplasms of the mediastinum consist of:
- symptoms of compression or tumor growth into neighboring organs and tissues;
- general manifestations of the disease;
- specific symptoms characteristic of various neoplasms;

Most frequent symptoms are pains that occur as a result of compression or tumor growth into nerve trunks or nerve plexuses, which is possible with both benign and malignant neoplasms of the mediastinum. The pain is usually mild, localized on the affected side, and often radiates to the shoulder, neck, and interscapular area. Pain with left-sided localization is often similar to pain caused by angina pectoris. If bone pain occurs, the presence of metastases should be assumed. Compression or germination of the borderline sympathetic trunk by a tumor causes the occurrence of a syndrome characterized by prolapse upper eyelid, pupil dilation and retraction eyeball on the affected side, impaired sweating, changes in local temperature and dermographism. Damage to the recurrent laryngeal nerve is manifested by hoarseness of voice, the phrenic nerve - by a high standing dome of the diaphragm. Compression spinal cord leads to spinal cord dysfunction.

A manifestation of compression syndrome is compression of large venous trunks and, first of all, the superior vena cava (superior vena cava syndrome). It manifests itself as a violation of the outflow venous blood from the head and upper half of the body: patients experience noise and heaviness in the head, worsening in an inclined position, chest pain, shortness of breath, swelling and cyanosis of the face, upper half of the body, swelling of the veins of the neck and chest. Central venous pressure rises to 300-400 mmH2O. Art. When the trachea and large bronchi are compressed, coughing and shortness of breath occur. Compression of the esophagus can cause dysphagia, an obstruction in the passage of food.

In the later stages of development of neoplasms, the following symptoms occur: general weakness, increased body temperature, sweating, weight loss, which are characteristic of malignant tumors. Some patients experience manifestations of disorders associated with intoxication of the body by products secreted by growing tumors. These include arthralgic syndrome, reminiscent of rheumatoid polyarthritis; pain and swelling of the joints, swelling of the soft tissues of the extremities, increase in heart rate, disturbance heart rate.

Some mediastinal tumors have specific symptoms. Thus, skin itching and night sweats are characteristic of malignant lymphomas (lymphogranulomatosis, lymphoreticulosarcoma). A spontaneous decrease in blood sugar levels develops with mediastinal fibrosarcomas. Symptoms of thyrotoxicosis are characteristic of intrathoracic thyrotoxic goiter.

Thus, clinical signs neoplasms, mediastinum are very diverse, however, they manifest themselves in the late stages of the disease and do not always allow an accurate etiological and topographic-anatomical diagnosis to be established. Data from radiological and instrumental methods are important for diagnosis, especially for recognizing the early stages of the disease.

Neurogenic tumors of the anterior mediastinum are the most common and account for about 30% of all primary mediastinal neoplasms. They arise from nerve sheaths (neurinomas, neurofibromas, neurogenic sarcomas), nerve cells (sympathogoniomas, ganglioneuromas, paragangliomas, chemodectomas). Most often, neurogenic tumors develop from elements of the border trunk and intercostal nerves, rarely from the vagus and phrenic nerves. The usual location of these tumors is the posterior mediastinum. Much less often, neurogenic tumors are located in the anterior and middle mediastinum.

Reticulosarcoma, diffuse and nodular lymphosarcoma(gigantofollicular lymphoma) are also called "malignant lymphomas." These neoplasms are malignant tumors of lymphoreticular tissue, most often affect young and middle-aged people. The tumor initially develops in one or more lymph nodes, followed by spread to neighboring nodes. Generalization occurs early. In a metastatic tumor process, in addition to lymph nodes, the liver, bone marrow, spleen, skin, lungs and other organs are involved. The disease progresses more slowly in the medullary form of lymphosarcoma (gigantofollicular lymphoma).

Lymphogranulomatosis (Hodgkin's disease) usually has a more benign course than malignant lymphomas. In 15-30% of cases in stage I of the disease, primary local damage to the mediastinal lymph nodes can be observed. The disease is more common between the ages of 20-45 years. The clinical picture is characterized by an irregular wave-like course. Weakness, sweating, periodic rises in body temperature, and chest pain appear. But characteristic of lymphogranulomatosis are skin itching, enlargement of the liver and spleen, changes in the blood and bone marrow are often absent at this stage. Primary lymphogranulomatosis of the mediastinum can be asymptomatic for a long time, with enlargement of the mediastinal lymph nodes for a long time may remain the only manifestation of the process.

At mediastinal lymphomas The lymph nodes of the anterior and anterior upper parts of the mediastinum and the roots of the lungs are most often affected.

Differential diagnosis is carried out with primary tuberculosis, sarcoidosis and secondary malignant tumors of the mediastinum. A test of radiation may be helpful in diagnosis, since malignant lymphomas are in most cases sensitive to radiation therapy(symptom of "melting snow"). The final diagnosis is established by morphological examination of the material obtained from a biopsy of the tumor.

Diagnosis of malignant neoplasms of the anterior mediastinum

The main method for diagnosing malignant neoplasms of the mediastinum is x-ray. Application of complex x-ray examination allows in most cases to determine the localization of the pathological formation - the mediastinum or neighboring organs and tissues (lungs, diaphragm, chest wall) and the extent of the process.

Mandatory X-ray methods for examining a patient with a mediastinal tumor include: - fluoroscopy, radiography and tomography of the chest, contrast examination of the esophagus.

Fluoroscopy makes it possible to identify a “pathological shadow”, get an idea of ​​its location, shape, size, mobility, intensity, contours, and establish the absence or presence of pulsation of its walls. In some cases, one can judge the connection between the identified shadow and nearby organs (heart, aorta, diaphragm). Clarification of the localization of the neoplasm largely makes it possible to predetermine its nature.

To clarify the data obtained during fluoroscopy, radiography is performed. At the same time, the structure of the darkening, its contours, and the relationship of the neoplasm to neighboring organs and tissues are clarified. Contrasting the esophagus helps to assess its condition and determine the degree of displacement or growth of a mediastinal tumor.

They are widely used in the diagnosis of mediastinal tumors. endoscopic methods research. Bronchoscopy is used to exclude bronchogenic localization of a tumor or cyst, as well as to determine whether a malignant tumor has invaded the mediastinum of the trachea and large bronchi. During this study, it is possible to perform a transbronchial or transtracheal puncture biopsy of mediastinal formations localized in the area of ​​the tracheal bifurcation. In some cases, mediastinoscopy and videothoracoscopy, in which the biopsy is performed under visual control, turns out to be very informative. Taking material for histological or cytological examination is also possible with transthoracic puncture or aspiration biopsy performed under X-ray control.

If there are enlarged lymph nodes in the supraclavicular areas, they are biopsied, which makes it possible to determine their metastatic lesions or establish a systemic disease (sarcoidosis, lymphogranulomatosis, etc.). If a mediastinal goiter is suspected, a scan of the neck and chest area is used after the administration of radioactive iodine. If compression syndrome is present, central venous pressure is measured.

Patients with mediastinal tumors undergo a general and biochemical blood test, the Wasserman reaction (to exclude the syphilitic nature of the formation), and a reaction with tuberculin antigen. If echinococcosis is suspected, determination of the latexagglutination reaction with echinococcal antigen is indicated. Changes in the morphological composition of peripheral blood are found mainly in malignant tumors (anemia, leukocytosis, lymphopenia, increased ESR), inflammatory and systemic diseases. If systemic diseases are suspected (leukemia, lymphogranulomatosis, reticulosarcomatosis, etc.), as well as immature neurogenic tumors, a bone marrow puncture is performed with the study of a myelogram.

Treatment of malignant neoplasms of the anterior mediastinum

Treatment of malignant neoplasms of the mediastinum- operational. Removal of tumors and cysts of the mediastinum must be done as early as possible, as this is the prevention of their malignancy or the development of compression syndrome. The only exceptions may be small lipomas and coelomic cysts of the pericardium in the absence of clinical manifestations and a tendency to their increase. Treatment of malignant tumors of the mediastinum in each specific case requires an individual approach. Usually it is based on surgical intervention.

The use of radiation and chemotherapy is indicated for most malignant tumors of the mediastinum, but in each specific case their nature and content are determined by the biological and morphological characteristics of the tumor process and its prevalence. Radiation and chemotherapy are used in combination with surgical treatment, and independently. As a rule, conservative methods form the basis of therapy for advanced stages of the tumor process, when radical surgery is impossible, as well as for mediastinal lymphomas. Surgical treatment for these tumors can only be justified if early stages diseases when the process locally affects a certain group of lymph nodes, which is not so common in practice. IN recent years A videothoracoscopy technique has been proposed and successfully used. This method allows not only to visualize and document mediastinal tumors, but also to remove them using thoracoscopic instruments, causing minimal surgical trauma to patients. The results obtained indicate the high effectiveness of this treatment method and the possibility of carrying out the intervention even in patients with severe concomitant diseases and low functional reserves.

A mediastinal tumor can be discovered completely by accident, during a routine examination, or during the diagnosis of completely different diseases. This type of neoplasm is called asymptomatic.

Other tumors manifest themselves quite clearly, causing the patient a lot of suffering. These formations can have different origins and nature, which determines the characteristics of their diagnosis, treatment and specific prognosis.

The mediastinum is the cavity between the organs located in the middle part of the chest. It is conventionally divided into upper and lower parts. The lower half, in turn, is divided into anterior, middle and posterior sections. The posterior mediastinum is divided into two more sections.

Such a complex division is necessary for more precise definition places of possible localization of the tumor. Tumors of the mediastinum can have a different nature, be malignant or benign, and be formed from various tissues, but they are all united by their location and origin outside the chest organs.

In addition to the tumors themselves, the group of mediastinal neoplasms includes cysts of various origins, including echinococcal, tuberculous nodes and formations in Beck’s sarcoidosis, vascular aneurysms related to pseudotumors.

Tumors of the mediastinum occur with equal frequency in both men and women, are more often found between the ages of 20 and 40 years, and relate to approximately 5–7% of all processes in the body accompanied by the development of space-occupying formations.

About 60–80% of all mediastinal tumors are benign neoplasms and cysts, and the remaining 20–40% are malignant.

Any tumors of the mediastinum represent a complex surgical problem due to the specific location, difficulties with diagnosis and removal, as well as the possibility of degeneration into malignant neoplasms, compression of neighboring organs, and the growth of metastases into them.

Also difficult to work with mediastinal tumors is the close location of vital organs - the heart, lungs and trachea, and large blood vessels.

Symptoms of the disease

Some types of tumors, mostly benign, such as lipomas, may not show any signs of their presence at all. Often, such neoplasms are discovered accidentally during examinations related to other diseases.

Malignant and large benign tumors of the mediastinum, the symptoms of which can manifest themselves differently, generally produce pain of varying degrees of intensity. This is due to compression of large vessels, important nerve nodes and endings. The pain can radiate to other parts of the body, most often to the shoulder and under the shoulder blade. If the tumor is on the left side of the chest, the patient may mistake the signs of its existence for angina pectoris and other symptoms of cardiac dysfunction.

Superior vena cava syndrome is one of the characteristic features the presence of a neoplasm. It causes noise and heaviness in the head, headaches and dizziness, sensations of lack of air, shortness of breath, blueness of the face, severe swelling, pain in the chest, bulging veins in the neck.

If the tumor puts pressure on the trachea, bronchi or lungs, the patient complains of shortness of breath, coughing, asthma attacks, and breathing problems.

When the esophagus is compressed, dysphagia occurs, that is, difficulty swallowing.The general symptoms of the disease are the appearance of weakness, unmotivated weight loss (with normal nutrition and physical activity), fever, joint pain - arthralgia, heart rhythm disturbances - tachycardia or bradycardia, pleurisy - inflammation of the serous membranes of the lungs.

There is a group of neoplasms that can cause specific symptoms. For example, with lymphomas of a malignant nature, severe itching and sweating at night may occur, signs of thyrotoxicosis develop with internal goiter, and neuroblastomas and other tumors of neurogenic origin can provoke diarrhea.

Danger of pathology

A threat to human health and life is not only posed by malignant neoplasms and metastases, which are potentially fatal in nature.

From the video you can find out how the procedure for removing a mediastinal tumor goes:

Even benign tumors located in the mediastinum pose a threat to life:

  • The first of them is the high risk of malignification, that is, degeneration into malignant tumors.
  • The second is compression and displacement of neighboring organs with disruption of their normal functioning, as well as deformation and disruption of the functioning of blood vessels and nerve endings.

All this gradually leads to the appearance of dysfunction internal organs and the development of diseases that are in no way related to tumors, but are provoked by their presence.

Another danger caused by the presence of a mediastinal tumor is the difficulty of detecting and removing such a large tumor. Sometimes they are located so that they literally cover the most important internal organs. This creates serious difficulties for surgeons, who must remove only tumor tissue and not affect vital organs and blood vessels, nerve endings.

Diagnostics

Due to the variety of symptoms that occur, diagnosing mediastinal tumors can be extremely difficult. Modern hardware techniques come to the rescue.

First of all, this is a chest X-ray, which is designed to identify existing changes. Then polypositional radiography is performed, that is, x-rays chest from different points, radiography of the esophagus.

These examinations may not be enough, so the patient is often prescribed a chest CT scan, MRI or MSCT of the lungs for visualization. Other methods for detecting tumors include endoscopic examination methods and sampling to determine the nature and origin of the formation.

In severe and unclear cases, a parasternal thoracotomy is performed, that is, opening the chest to examine the mediastinum.

In addition to hardware and instrumental examinations, the patient is prescribed all basic tests, including and, as well as other tests at the request of the doctor.

Classification of tumors

Mediastinal tumors are classified by origin, that is, by the type of tissue from which they are formed:

  • Lymphoid neoplasms. The most common types are lymphogranulomatosis, lymphosarcoma and reticulosarcoma.
  • Tumors of the thymus gland. These are common thymomas that can be benign or malignant.
  • Neurogenic tumors. These are ganglioneuromas, malignant and benign neuromas, neurofibromas and other formations.
  • Mesenchymal neoplasms. This group includes fibromas, lipomas, hemangiomas, liposarcomas, fibrosarcomas, angiosarcomas, and so on.
  • Dysembryogenetic formations are tumors that develop in the fetus in utero. Sometimes they may contain particles from the twin absorbed in the womb. Such tumors are called teratomas, but this group also includes internal goiter and other neoplasms that arise during fetal formation, for example, chorionepitheliomas and seminomas.

Mediastinal neoplasms can also be classified according to other characteristics, for example, by location in different parts of this anatomical part of the body.

Features of treatment and prognosis

If a patient is diagnosed with a mediastinal tumor, the symptoms of which indicate its origin, the doctor decides to remove it as quickly as possible. As with tumors of other organs, mediastinal tumors should be removed at the earliest stages to obtain the maximum positive result. Due to the peculiarities of the position, any space-occupying formations in the mediastinum entail negative consequences for neighboring organs.

In the case of benign tumors, they are removed by thoracoscopy or using classical surgical techniques. The choice of method depends on the origin of the tumor, its size and location. If it is small and distant from large blood vessels and nerve nodes and nearby organs, then it is removed without opening the chest. In other situations, you have to resort to traditional surgery.

Metastases are also particularly dangerous. If the tumor is operable, it is removed entirely and nearby tissue is removed to avoid the appearance of metastases. In the case of an advanced tumor, its removal is carried out for palliative purposes, to reduce the load on the organs and reduce the negative impact on the patient’s body.

In the presence of oncological diseases of the mediastinum and metastases, the decision to prescribe chemotherapy and radiation is made by the doctor individually for each patient. It may be part general treatment after surgery or prescribed independently of surgery.In addition, the patient is prescribed symptomatic treatment, that is, they give drugs aimed at reducing and disappearing symptoms: painkillers, anti-inflammatory drugs, antibiotics, restoratives, and so on.

The prognosis can be positive with early detection of tumors, their small size, benign nature, absence of metastases and dangerous tumor growth into organs, blood vessels or nerves.

This type of disease is displayed as a tumor and cyst; the causes of the disease may depend on the age of the person and the location of the formation in the middle, posterior and anterior mediastinum. In this case, formations can be either asymptomatic, which most often appear in adults, or cause obstruction respiratory tract which is most common in children. At the time of diagnosis, CT was used, but other studies can be performed if necessary.

What can cause mediastinal masses?

Essentially, they are divided into special groups, and each of them has special characteristic formations. If we consider the anterior group, it is limited to the area of ​​the sternum, brachiocephalic vessels and pericardium. The middle group includes the location between the posterior and middle mediastinum. The posterior group is limited to the trachea and pericardium, and can also appear in the spinal region. As for children, often formations appear such as a cyst or tumor. As for adults, this includes thymoma and neutrogenic tumors. Lymphomas also occur, but only between the ages of 20 and 40.

Symptoms of mediastinal formation

In fact, the symptoms of the formation should depend only on the location, and asymptomatic ones are most common. Much more often accompanied by the development of clinical symptoms - malignant tumor compared to benign. Such symptoms manifest themselves as chest pain and decreased body weight. In childhood, symptoms appear when they cause compression of the bronchi and trachea, as well as stridor, pneumonia, and recurrent bronchitis. The formation of the anterior mediastinum when large in size causes shortness of breath when lying on the back. The middle mediastinum compresses the airways and blood vessels. As a result, this leads to the development of superior genital vein syndrome or airway obstruction. The posterior mediastinum compresses the esophagus and, as a result, grows into it. Ultimately, this can lead to the development of odynophagia or dysphagia.

Diagnosis of mediastinal formation

In some cases, space-occupying formations in the mediastinum may occur during radiography of organs in the chest area. It can also manifest itself in other radiation studies that are performed as clinical symptoms in the chest area. Additional diagnostic studies may also be carried out, and most often these are biopsy and radiation, which must be carried out in order to make it easier to determine the type of formation.

CT, which has intravenous contrast, is considered a more informative imaging method. It is possible to differentiate CT from other processes with a high degree of confidence in the area of ​​the chest of normal structure with a cyst or benign tumor. The correct diagnosis is established for various mediastinal formations, as a result of core needle biopsy and fine needle aspiration biopsy. Where fine needle aspiration biopsy is necessary for malignant processes if thymoma or lymphoma is suspected. With this process, it is necessary to do a core biopsy. If tuberculosis is suspected, then it is necessary to carry out tuberculin test. If ectopic tissue in the area is suspected thyroid gland it is necessary to conduct a study of the concentration of thyroid-stimulating hormone.

Treatment of mediastinal formation

The treatment itself will depend on the type of space-occupying formation; there are special benign formations, pericadral cyst, which can also be observed. Many malignant tumors must be removed only by surgery, but in special cases it is necessary to carry out chemotherapy. When granulomatous diseases manifest themselves, it is imperative to carry out adequate antimicrobial therapy.

Indications for surgical treatment

It is imperative to perform surgical intervention when mediastinal neoplasms appear. Diseases such as sarcoma, carcinoid tumors and invasive thymoma will not be in doubt. But exceptions can be noted; these are mediastinal lymphomas, and for such treatment it is necessary to use chemoradiotherapy. Let's look at the indications for surgical treatment; it can be determined by the following circumstances.

First of all, it can be noted that any formation can manifest itself in a malignant form. And if you use conservative tactics in the absence of reliable morphological confirmation, this leads to invasion of vital structures and organs. For such a case, it is best to use a study of the surgical drug. Other methods will not bring complete confidence.

Every benign or malignant volumetric process that is displayed in a confined space contains a potential threat. Based on all the recommendations provided regarding indications for surgical treatment, the following points can be included. The histological diagnosis of any mediastinal formations could not plausibly clarify the morphological diagnostic method. Malignant tumors with distant metastases are complicated by mediastinal compression, as well as any locally advanced and local formations, with the exception of mediastinal lymph nodes.

Considering that asymptomatic cysts or other benign formations will be absolutely harmless, they belong to non-surgical treatment. In this case, it is impossible to give consent from a conservative point of view, since a benign tumor and cyst are not as dangerous when considered in relation to organ compression syndrome compared to malignant neoplasms. There is a lot of information in the medical literature about various variants of mediastinal compression syndrome, which are caused by benign pathology.

Contraindications to surgical treatment

Considering that every voluminous formation is associated with risk dangerous complications for the patient’s life, then it is best to note here not only about contraindications to surgical treatment, but also about the principles of choosing the method of surgical aggression. Using modern surgical technology, it is possible to perform interventions of varying volumes, reconstruction and resection on many anatomical structures.

Mediastinal compression syndrome in various clinical variants can be considered not only a contraindication, but also a frequent vital indication in the field of surgical intervention. Wide abdominal interventions in the area of ​​mediastinal formation will be contraindicated if severe coronary, respiratory, renal, hepatic, or cerebral insufficiency manifests itself. Only if they are not associated with the formation of the mediastinum. If this happens, then the issue will need to be resolved individually.

Neoplasms are abnormal growths of tissue that can occur in almost any area of ​​the body. The mediastinum is the area in the middle of the chest between the sternum and the spine, which contains the vital organs - the heart, esophagus, trachea. Tumors that develop in this area are called mediastinal tumors.

This type of tumor is very rare.

Classification and location of mediastinal tumors

Mediastinal tumors can develop in one of three areas: in the front, middle or back.

The location of the tumor in the mediastinum is usually depends on the patient's age .

Children are more likely to develop tumors in the posterior mediastinum.

The growths are often benign (not cancerous). In adults, abnormal tissue growth is observed in the anterior part and tumors are usually malignant (cancerous). Adult patients with this type of pathology are most often aged from 30 to 50 years.

Causes of tumors and symptoms indicating a dangerous disease

There are a number various types mediastinal tumors. The cause of these neoplasms is directly related to the location where they are formed.

In the anterior part of the mediastinum:

  1. Lymphomas, including Hodgkin's disease and non-Hodgkin's lymphomas.
  2. Thymoma and cyst-tumor of the thymus.
  3. Oncological pathologies of the thyroid gland, as a rule, show benign growth, but can sometimes be cancerous.

In the middle mediastinum, tumors often develop due to:

  1. Bronchogenic cystic benign growth that begins in the respiratory system.
  2. Enlarged mediastinal lymph nodes.
  3. Benign myocardial cyst.
  4. Thyroid mass of the mediastinum.
  5. Tumors of the trachea, usually benign.
  6. Vascular complications - such as aortic edema.

In the posterior part of the mediastinum:

  1. Extramedullary rare growths that begin in the bone marrow and are associated with severe anemia.
  2. Pathology of the mediastinal lymph nodes.
  3. Neuroenteric cyst of the mediastinum is a very rare growth involving both nerves and cells of the gastrointestinal tract.
  4. Neurogenic tumor of the mediastinum is the most common case among posterior tumors mediastinum. In this case, the basis of the tumor is cancerous cells of the nerves. It is worth noting that about 70 percent of them are benign.

Tumors that form in the mediastinum are known as primary neoplasms. Sometimes they develop due to metastases cancer cells from another part of the body. The spread of cancer from one part of the body to another is one of the indicators of the malignancy of the process, therefore, in this case, mediastinal tumors always have a similar structure. It is worth noting that malignant neoplasms of the mediastinum often form as median ones.

Mediastinal tumor may not have any symptoms .

Neoplasms are usually discovered during chest x-ray performed to diagnose other diseases.

If symptoms develop, this is a classic indicator that the tumor has begun to spread to surrounding organs, most often to the lungs, with all the similar signs of the corresponding pathology.

Symptoms of a mediastinal tumor:

  • Cough
  • Irregular breathing
  • Chest pain
  • Fever/chills
  • Night sweats
  • Coughing up blood
  • Unexplained weight loss
  • Enlarged lymph nodes
  • Respiratory blockage
  • Sleep apnea
  • Hoarseness

Methods for diagnosing mediastinal tumors

The most commonly used methods for diagnosing mediastinal tumors include:

  1. Chest X-ray.
  2. Computed tomography (CT) of the chest.
  3. CT-guided biopsy.
  4. chest.
  5. Mediastinoscopy with biopsy. A rather labor-intensive method that is performed under general anesthesia. This examination of the chest cavity uses a special tube inserted through a small incision under the breastbone. Microscopy of a sample of the resulting tissue can determine the presence of cancer cells. Mediastinoscopy with biopsy allows doctors to accurately diagnose from 80% to 90% of all mediastinal tumors, of which 95% to 100% of anterior tumors.

Treatment methods and prognosis in the presence of tumors in the mediastinum

Treatment used against mediastinal tumors depends on the type of tumor and its location.

  • Cancerous tumors of the thymus require mandatory surgical intervention, followed by radiation or chemotherapy. Types of surgery include thoracoscopy (minimally invasive approach), mediastinoscopy (minimally invasive), and thoracotomy (the procedure is performed through an open incision in the chest wall.
  • Lymphomas It is recommended to treat with chemotherapy followed by radiation.
  • Neurogenic tumors , found in posterior region mediastinum, can only be treated surgically.

Compared to traditional surgery, patients treated with minimally invasive techniques—such as thoracoscopy or mediastinoscopy—experience less pain during the procedure.

Advantages of minimally invasive operations in the treatment of mediastinal tumors:

  1. Reduced postoperative pain.
  2. Short hospital stay after surgery.
  3. Faster recovery and return to normal quality of life.
  4. Other possible benefits include a reduced risk of infection and less postoperative bleeding.

Risks of minimally invasive methods include complications of radiation and chemotherapy. It is worth noting that any surgical intervention is first discussed with the patient and a number of additional examinations are carried out in order to select best method treatment.

Possible complications of minimally invasive surgical treatment include:

  1. Damage to surrounding tissues and organs, such as the heart, pericardium, or

A mediastinal tumor is a neoplasm in the mediastinal space of the chest, which can vary in morphological structure. Benign neoplasms are often diagnosed, but approximately every third patient is diagnosed with oncology.

There are a large number of predisposing factors that determine the appearance of a particular formation, ranging from addiction to bad habits and dangerous working conditions, ending with the metastasis of a cancerous tumor from other organs.

The disease manifests itself in a large number of pronounced symptoms that are quite difficult to ignore. The most characteristic external signs include severe cough, shortness of breath, headaches and increased body temperature.

The basis of diagnostic measures is instrumental examinations of the patient, the most informative of which is considered to be a biopsy. In addition, a medical examination will be required and laboratory tests. Treatment of the disease, regardless of the nature of the tumor, is only surgical.

Etiology

Despite the fact that tumors and cysts of the mediastinum are a rather rare disease, its occurrence in most cases is caused by the spread oncological process from other internal organs. However, there are a number of predisposing factors, among which it is worth highlighting:

  • long-term addiction to bad habits, in particular smoking. It is worth noting that the more experience a person has of smoking cigarettes, the greater the likelihood of acquiring such an insidious disease;
  • decreased immune system;
  • contact with toxins and heavy metals – this can include both working conditions and unfavorable conditions environment. For example, living near factories or industrial enterprises;
  • constant exposure to ionizing radiation;
  • prolonged nervous overstrain;
  • poor nutrition.

This disease occurs equally in both sexes. The main risk group consists of people of working age - from twenty to forty years. In rare cases, malignant or benign neoplasms of the mediastinum can be diagnosed in a child.

The danger of the disease lies in the wide variety of tumors, which may differ in their morphological structure, damage to vital organs and the technical complexity of their surgical excision.

The mediastinum is usually divided into three floors:

  • upper;
  • average;
  • lower.

In addition, there are three sections of the lower mediastinum:

  • front;
  • rear;
  • average.

Depending on the part of the mediastinum, the classification of malignant or benign neoplasms will differ.

Classification

According to the etiological factor, mediastinal tumors and cysts are divided into:

  • primary – originally formed in this area;
  • secondary – characterized by the spread of metastases from malignant tumors that are located outside the mediastinum.

Since primary neoplasms are formed from various tissues, they will be divided into:

  • neurogenic tumors of the mediastinum;
  • mesenchymal;
  • lymphoid;
  • thymus tumors;
  • dysembryogenetic;
  • germ cell - develop from the primary germ cells of the embryo, from which sperm and eggs should normally be formed. It is these tumors and cysts that are found in children. There are two peaks of incidence - in the first year of life and in adolescence- from fifteen to nineteen years.

There are several most common types of neoplasms, which will differ in their location. For example, tumors of the anterior mediastinum include:

  • neoplasms of the thyroid gland. They are often benign, but sometimes they are cancerous;
  • thymoma and thymic cyst;
  • mesenchymal tumors;

In the middle mediastinum, the most common formations are:

  • bronchogenic cysts;
  • lymphomas;
  • pericardial cysts.

A tumor of the posterior mediastinum manifests itself:

  • enterogenous cysts;
  • neurogenic tumors.

In addition, clinicians usually distinguish between true cysts and pseudotumors.

Symptoms

For quite a long period of time, tumors and cysts of the mediastinum can occur without expressing any symptoms. The duration of this course is determined by several factors:

  • place of formation and volume of neoplasms;
  • their malignant or benign nature;
  • the rate of tumor or cyst growth;
  • relationship with other internal organs.

In most cases, asymptomatic mediastinal tumors are discovered completely by accident - during fluorography for another disease or for preventive purposes.

As for the period of expression of symptoms, regardless of the nature of the tumor, the first sign is pain in the chest area. Its appearance is caused by compression or germination of the formation into the nerve plexuses or endings. The pain is often moderate. The possibility of irradiation cannot be ruled out pain in the area between the shoulder blades, in the shoulders and neck.

Against the background of the main manifestation, other symptoms of mediastinal tumors begin to appear. Among them:

  • fatigue and malaise;
  • increased body temperature;
  • severe headaches;
  • bluish lips;
  • dyspnea;
  • swelling of the face and neck;
  • cough - sometimes with blood;
  • uneven breathing, even attacks of suffocation;
  • heart rate instability;
  • profuse sweating, especially at night;
  • causeless weight loss;
  • increase in the volume of lymph nodes;
  • hoarseness of voice;
  • night snoring;
  • increased blood pressure;
  • slurred speech;
  • disruption of the process of chewing and swallowing food.

In addition to the above symptoms, myasthenic syndrome very often appears, which is manifested by muscle weakness. For example, a person cannot turn his head, open his eyes, or raise his leg or arm.

Similar clinical manifestations are typical for mediastinal tumors in children and adults.

Diagnostics

Despite the variety and specificity of the symptoms of such a disease, it is quite difficult to establish a correct diagnosis based on them. For this reason, the attending physician prescribes a whole range of diagnostic examinations.

Primary diagnosis includes:

  • a detailed interview with the patient will help determine the first time of onset and the degree of intensity of symptom expression;
  • a clinician’s examination of the patient’s medical history and life history to determine the primary or secondary nature of the tumors;
  • a thorough physical examination, which should include auscultation of the patient’s lungs and heart using a phonendoscope, examination of the condition of the skin, and measurement of temperature and blood pressure.

General laboratory diagnostic techniques do not have any particular diagnostic value; however, clinical and biochemical analysis blood. A blood test is also prescribed to determine tumor markers that will indicate the presence of a malignant neoplasm.

In order to determine the location and nature of the neoplasm according to the classification of the disease, it is necessary to carry out instrumental examinations, including:


Treatment

After confirming the diagnosis, a benign or malignant mediastinal tumor should be surgically removed.

Surgical treatment can be carried out in several ways:

  • longitudinal sternotomy;
  • anterolateral or lateral thoracotomy;
  • transthoracic ultrasound aspiration;
  • radical extended surgery;
  • palliative removal.

In addition, if the tumor is malignant, treatment is supplemented with chemotherapy, which is aimed at:

  • reduction of the volume of malignant formation - carried out before the main operation;
  • the final elimination of cancer cells that may not have been completely removed during surgery;
  • elimination of a tumor or cyst - in cases where surgical therapy cannot be performed;
  • maintaining the condition and prolonging the patient’s life – when diagnosing a severe form of the disease.

Can be used as well as chemotherapy radiation treatment, which can also be the main or auxiliary technique.

There are several alternative methods fight against benign tumors. The first of them consists of a three-day fast, during which you need to refuse any food, and you are allowed to drink only purified water without gas. When choosing such treatment, you must consult with your doctor, since fasting has its own rules.

The therapeutic diet, which is part of complex therapy, includes:

  • frequent and fractional food consumption;
  • complete rejection of fatty and spicy foods, offal, canned food, smoked meats, pickles, sweets, meat and dairy products. It is these ingredients that can cause the degeneration of benign cells into cancerous ones;
  • enriching the diet with legumes, dairy products, fresh fruits, vegetables, cereals, dietary first courses, nuts, dried fruits and herbs;
  • cooking food only by boiling, steaming, stewing or baking, but without adding salt and fat;
  • plenty of drinking regime;
  • control over the temperature of food - it should not be too cold or too hot.

Besides this, there are several folk remedies that will help prevent the onset of cancer. The most effective of them include:

Potato flowers will help
prevent cancer

  • potato flowers;
  • hemlock;
  • honey and mumiyo;
  • golden mustache;
  • apricot kernels;
  • sagebrush;
  • white mistletoe.

It is worth noting that starting such therapy on your own can only aggravate the course of the disease, which is why before using folk recipes You should consult your doctor.

Prevention

There are no specific preventive measures, which can prevent the appearance of a tumor in the anterior mediastinum or any other location. People need to follow a few general rules:

  • give up alcohol and cigarettes forever;
  • follow safety rules when working with toxins and poisons;
  • If possible, avoid emotional and nervous stress;
  • follow nutritional recommendations;
  • strengthen immunity;
  • undergo fluorographic examination annually for preventive purposes.

There is no unambiguous prognosis for such a pathology, since it depends on several factors - location, volume, stage of development, origin of the tumor, the age category of the patient and his condition, as well as the possibility of surgery.

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