Mediastinal tumors

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MEDIASTINAL TUMORS

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MEDIASTINAL TUMORS

MEDIASTINAL TUMORS

CONTENTS

ANATOMY AND CLINICAL CORRELATION APPROACH TO A MEDIATINAL TUMOROVERVIEW OF DIFFERENT MEDIASTNAL TUMOR

ANATOMY OF MEDIASTINUM BORDERS OF MEDIASTINUM COMPARTMENTS OF MEDIASTINUM CONTENTS OF MEDIASTINUM

ANTERO SUPERIOR THYMUSLYPMH NODESFAT

MIDDLE PERICARDIUMHEART ASCENDING AORTASVC PULMONARY VEINPULMONARY ARTERY PHRENIC NERVEBIFURCATION OF TRACHEA LYMPHNODE

POSTERIOROESOPHAGUS DESCENDING AORTAAZYGOS VEINHEMI AZYGOS VEINACCESORY AZYGOS VEINSYMPATHETIC CHAINVAGUS NERVETHROACIC DUCT LYMPH NODES

CLINICAL CORRELATION ANTERO SUPERIOR COMPARTMENT THYMOMA ( ADULT ) GERM CELL TUMOR LYMPHOMA RETROSTERNAL GOITREMIDDLE COMPARTMENT LYMPHOMA TUMORS OF BLOODVESSELS TUMORS OF HEARTPOSTERIOR COMPARTMENT NEUROGENIC TUMORS ( CHILDREN ) LYMPHOMA

CONTENTS

ANATOMY AND CLINICAL CORRELATION APPROACH TO A MEDIASTINAL TUMOROVERVIEW OF DIFFERENT MEDIASTINAL TUMOR

APPROACH TO MEDIASTINAL TUMORSCLINICAL PRESENTATION

INCIDENTALLY NOTICED SYMPTOMS DUE TO COMPRESSION SYSTEMIC SYMPTOMS

APPROACH TO MEDIASTINAL TUMORS

DIAGNOSISAGE SYMPTOMSIMAGING STUDIES (ANATOMICAL LOCATION ) THYMOMA - COMMON IN ADULTS NEUROGENIC TUMORS COMMON IN CHILDREN PRESSURE SYMPTOMS STRIDORDYSPNEACOUGH HEMOPTYSIS FACE AND UPPER EXTREMITY SWELLINGCARDIAC TAMPONADEPLEURAL EFFUSION DYSPHAGIA HORNER SYNDROME

SYSTEMIC SYMPTOMS FEVER , NIGHT SWEATS , WEIGHT LOSS LYPHOMADIPLOPIA , PTOSIS , DYSPHAGIA MYASTHENIA GRAVIS

X-RAY PA AND LATERAL VIEWCT CHEST WITH CONTRAST

TUMOR MARKERS ANTI ACETYL CHOLINE ANTIBODIES - MYASTHENIA GRAVIS -FETO PROTEIN AND -HCG GERM CELL TUMORS

MRI - CONFIRM INVASION OR SPINAL CANAL INVOLVEMENT

FNAC / CORE BIOSPSY

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APPROACH TO MEDIASTINAL TUMORS TREATMENT

SURGERY

CHEMOTHERAPY AND RADIATION MINIMALLY INVASIVE VATS , ROBOTIC OPEN APPROACH MEDIAN STERNOTOMY THOROCOTOMY

CONTENTS

ANATOMY AND CLINICAL CORRELATION APPROACH TO A MEDIASTINAL TUMOROVERVIEW OF DIFFERENT MEDIASTINAL TUMOR

OVERVIEW OF DIFFERENT MEDIASTINAL TUMORS THYMOMANEUROGENIC TUMORSGERM CELL TUMORSLYMPHOMA

THYMOMA

SEEN BETWEEN 40 60 YRS ASSOCIATED WITH PARANEOPLASTIC SYNDROMES LIKE MYASTHENIA , RED CELL APLASIA, HYPOGAMMAGLOBLINEMIA, SLE2 STAGINGS MASAOKA AND WHO

Stage I Completely encapsulated .Stage II Capsular invasion. IIA: Microscopic capsular invasion IIB: Macroscopic invasion into surrounding fatty tissue or adherent to but not through the mediastinal pleura or pericardiumStage III Pericardial or lung involvement. IIIA: Macroscopic invasion into pericardium or lung without great vessel invasion IIIB: Macroscopic invasion into pericardium or lung with great vessel invasionStage IV Disseminated disease. IVA: Pleural or pericardial dissemination IVB: Lymphatic or hematogenous metastases

TREATMENT : STAGE 1 AND 2 COMPLETE RESECTION STAGE 3 AND 4 COMPLETE RESECTION + POST OP RADIATION POST OP CHEMOTHERAPY CISPLATIN, DOXORUBICIN, CYCLOPHOSPHAMIDE

IN UNRESECTABLE TUMOR PRE OP CHEMOTHERAPY [OR] RADIOTHERAPY IS DONE .

OVERVIEW OF DIFFERENT MEDIASTINAL TUMORS THYMOMANEUROGENIC TUMORSGERM CELL TUMORSLYMPHOMA

NEUROGENIC TUMORS ORIGIN SYMPATHETIC GANGLIA : GANGLIOMA GANGLIO-NEUROBLASTOMA NEUROBLASTOMANERVE SHEATH : NEUROLEMOMA(SCHWANOMA) NEUROFIBROMA NEUROSARCOMAPARAGANGLION CELLS :- PHEOCHROMOCYTOMA NEUROBLASTOMA CHILDHOOD TUMOR COMMONLY SEEN IN ADRENAL MEDULLAOTHER SITE SYMPATHETIC CHAIN ARISE FROM NEUROBLASTIC CELLS C/F MASS IN LOIN OR CHEST (PRESSURE SYMPTOM) OTHER MANIFESTATIONS - RACOON EYE SIGN , OPSOMYOCLONUS SYNDROME , HYPERTENSION , FLUSHING , DIARRHOEA (VIP) INVESTIGATION CT OR MRI , VANILYL MANDELIC ACID (VMA ) , HOMOVANILIC ACID (HVA) , MIBG( META IODO BEZYL GUANIDINE) SCAN , BONE MARROW BIOPSY

GRADING OF NEUROBLASTOMABASED ON AGE , EXTENT OF DISEASE , HISTOLOGY , N-MYC ONCOGENE

LOW RISK 90% - SURGICAL EXCISION INTERMEDIATE RISK 70 % EXCISION AND RADIOTHERAPY HIGH RISK 30 % DEBULKING , RADIATION AND CHEMOTHERAPY (CISPLATIN , DOXORUBICIN , CYCLOPHOSPHAMIDE ) AND SECOND LOOK SURGERY

NEUROGENIC TUMORS ORIGIN SYMPATHETIC GANGLIA : GANGLIOMA GANGLIO-NEUROBLASTOMA NEUROBLASTOMANERVE SHEATH : NEUROLEMOMA(SCHWANOMA) NEUROFIBROMA NEUROSARCOMAPARAGANGLION CELLS :- PHEOCHROMOCYTOMA

PHEOCHROMOCYTOMA

TUMOR ARISES FROM CHROMAFFIN CELLS SEEN COMMONLY IN ADRENAL MEDULLA EXTRA ADRENAL ( PARAGANGLIONS ) THESE TUMOR SECRETES NORADRENALINE AND ADRENALINE RULE OF 10S : 10% - MALIGNANT , EXTRAADRENAL , BILATREAL , FAMILIAL , MULTIPLE , NON HYPERTENSIVE CLINICAL FEATURES HEADACHE , PALPITATION , FLUSHING , WEAKNESS , HYPERTENSION , ASSOSIATED WITH MEN 2 , VHL , NF TYPE 1 .

INVESTIGATION 24 HR URINE OR BLOOD SAMPLE - METANEPHRINE & NORMETANEPHRINE MRI FOR LOCALISATION MIBG SCAN TREATMENT : INTIALLY - BLOCKER (PHENOXYLBENZAMINE) IS GIVEN FOR 10 DAYS THEN START BLOCKERS SURGICAL EXCISION OF TUMOR IS DONE .

MALIGNANT PHEOCHROMOCYTOMA SURGERY + I-131 MIBG + POST OP CHEMOTHERAPY - MITOTANE + CYCLOPHOSPHAMIDE , VINCRISTINE , DACARBAZINE .

NEUROGENIC TUMORS ORIGIN SYMPATHETIC GANGLIA : GANGLIOMA GANGLIO-NEUROBLASTOMA NEUROBLASTOMANERVE SHEATH : NEUROLEMOMA(SCHWANOMA) NEUROFIBROMA NEUROSARCOMAPARAGANGLION CELLS :- PHEOCHROMOCYTOMA

NEUROFIBROMAARISE FROM SCHWANN CELLS AND CONNECTIVE TISSUES TYPES CUTANEOUS SMALL , HARD , MULTIPLE NODULES PLEXIFORM LARGE , HARD MASS NON TENDER , PARAESTHESIA ,MOVE PERPENDICULAR TO THE NERVECOMMONLY ASSOCIATED WITH NEUROFIBROMATOSIS TYPE 1 CHROMOSOME 17 MUTATION , NF-1 GENE .OTHER FEATURES AXILLARY FRECKLES , LISCH NODULES, CAF AU LAIT SPOT . INVESTIGATION CT/MRI , SLIT LAMP , MOLECULAR TESTING . TREATMENT SURGICAL EXCISION

NEUROGENIC TUMORS ORIGIN SYMPATHETIC GANGLIA : GANGLIOMA GANGLIO-NEUROBLASTOMA NEUROBLASTOMANERVE SHEATH : NEUROLEMOMA(SCHWANOMA) NEUROFIBROMA NEUROSARCOMAPARAGANGLION CELLS :- PHEOCHROMOCYTOMA

SCHWANNOMAARISE FROM SCHWANN CELLS , BENIGN TUMORSCAN OCCUR AT ANY SITE ASSOCIATED WITH NEUROFIBROMATOSIS TYPE - 2 CAUSING ACOUSTIC NEUROMA . C/F HEARING LOSS , PARAESTHESIA , SOMETIMES TENDER . INVESTIGATION CT/MRI , AUDIOMETRY . TREATMENT SURGICAL EXCISION

NEUROGENIC TUMORS ORIGIN SYMPATHETIC GANGLIA : GANGLIOMA GANGLIO-NEUROBLASTOMA NEUROBLASTOMANERVE SHEATH : NEUROLEMOMA(SCHWANOMA) NEUROFIBROMA NEUROSARCOMAPARAGANGLION CELLS :- PHEOCHROMOCYTOMA

OVERVIEW OF DIFFERENT MEDIASTINAL TUMORS THYMOMANEUROGENIC TUMORSGERM CELL TUMORSLYMPHOMA

OVERVIEW OF DIFFERENT MEDIASTINAL TUMORS THYMOMANEUROGENIC TUMORSGERM CELL TUMORSLYMPHOMACYSTS

GERM CELL TUMORS DUE TO FAILURE OF MIGRATION OF GERM CELLS

GERM CELL TUMORS

TERATOMA IS THE COMMONEST IN MEDIASTINUM C/F PRESSURE SYMPTOMS INVESTIGATION CT / MRI , X-RAY TREATMENT SURGICAL EXCISION SEMINOMATOUS TUMOR RADIOSENSITIVE AND CHEMOSENSITIVE NON SEMINOMATOUS CHEMOSENSITIVE CHEMOTHERAPY BEP (BLEOMYCIN , ETOPOSIDE , CISPLATIN)

SEMINOMATOUS NON- SEMINOMATOUS

OVERVIEW OF DIFFERENT MEDIASTINAL TUMORS THYMOMANEUROGENIC TUMORSGERM CELL TUMORSLYMPHOMA

OVERVIEW OF DIFFERENT MEDIASTINAL TUMORS THYMOMANEUROGENIC TUMORSGERM CELL TUMORSLYMPHOMA

LYMPHOMA2 TYPES HODGKINS AND NON-HODGKINSSITE : HODGKINS - MAINLY CERVICAL OTHER SITE MEDIASTINUM , AXILLARY , INGUINAL NON- HODGKINS WALDEYERS RING , EPITROCHLEAR , ABDOMINAL ( MALT ) C/F PRESSURE SYMPTOMS , FEVER , WEIGHT LOSS , NIGHT SWEATS, ANAEMIA , BONE PAIN . INVESTIGATION X-RAY , CT TREATMENT RADIOTHERAPY CHEMOTHERAPY MOPP ( MUSTINE ,ONCOVINE {VINCRISTINE} , PROCARBAZINE, PREDNISOLONE) ABVD - ADRIAMYCIN , BLEOMYCIN , VINBLASTINE DACARBAZINE

OVERVIEW OF DIFFERENT MEDIASTINAL TUMORS THYMOMANEUROGENIC TUMORSGERM CELL TUMORSLYMPHOMA

MEDIASTINAL CYSTS PERICARDIAL CYST BRONCHOGENIC CYST ENTERIC CYST THYMIC CYST