Where is the Mediastinum?

mediastinum It is not a very well known term. But when it is said as the tissue called sleepiness in animals, it comes to everyone’s mind as the area behind the breastbone. Mediastinum is the general name of the space between the two lungs in the thoracic cavity.

Within this space are the heart, great vessels, trachea, esophagus, some nerve pathways, lymph nodes, adipose tissue and the thymus gland, popularly known as sleepiness.

What are the most common mediastinal tumors?

Tumors arising directly from mediastinal tissues are rare. The most common tumors are the conditions that occur when lung cancer spreads to the lymph nodes. For example, small cell lung cancer most commonly spreads to the mediastinal lymph nodes. In addition, squamous (squamous) cell cancer may spread to the mediastinal lymph nodes. Apart from that, lymphomas (lymph cancers) are the most common tumors in the middle mediastinum. When we move to the posterior region, tumors originating from the nerve chain are seen. They are generally benign (benign) in character. The most common type is ganglioneuromas.

When we come to the front, thymomas (thymus tumors) are common.

In addition, problems that arise in the progression of cells during the development of the baby may manifest themselves as tumors in later life, such as germ cell tumors in young men or teratomas in women.

What complaints do these patients present with?

Small tumors are often found incidentally. Lung cancers or when other mediastinal tumors enlarge and press on large vessels, a picture that we call superior vena cava syndrome, swelling of the face and neck, and prominent veins may occur. Patients with lymphoma often experience weakness, weight loss, fever and night sweats. Nerve-derived tumors, which we call neurogenic tumors, usually do not show any symptoms until they become very large. Thymomas and other tumors located in the anterior mediastinum do not give much indication unless they reach very large sizes.

What tests are done?

The disease is usually noticed on chest X-ray and a contrast-enhanced computed tomography (CT) of the thorax is performed immediately. Then, in some cases, magnetic resonance (MR) is performed to clearly reveal the vessel extension. In germ cell tumors located in the anterior region, beta-HCG and alpha-fetoprotein tests are performed from the blood to determine the origin of the tumor.

How is it diagnosed?

In lung cancers extending to the mediastinum, it is usually bronchoscopy (examination of the inside of the trachea with a lighted tube) and endobronchial ultrasonography (ultrasound analysis through the trachea) and the result is obtained. Tumors in the anterior region can be diagnosed by tomography-guided thick needle (trucut) biopsy. In cases where it cannot be placed, the result is obtained by taking a piece with the closed chest surgery method called VATS.

How is the Treatment in Mediastinal Tumors?

Treatments vary according to the type of tumor. In lung cancers that have spread to the mediastinum or have spread to the lymph nodes, the treatment method is either preoperative (neoadjuvant) chemotherapy or only chemoradiotherapy. Thymomas are surgically removed if they are not very large and there is no vascular involvement. The same is true for teratomas and neurogenic (nerve origin) tumors. Sometimes nerve-derived tumors extend to the spinal cord and may need to be operated jointly with neurosurgery.

In germ cell tumors, chemotherapy and sometimes surgery are applied together, depending on the cell type.

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