Written by: Prof. Dr. Semih Halezeroğlu / Head of the Department of Thoracic Surgery, Acıbadem University Faculty of Medicine. In this article, information is provided about what Mediastinal Tumors and Cysts are, how they occur, what their symptoms are, and what international sources recommend. In light of this information, detailed information can be found regarding the diagnosis, treatment, surgical methods, risks of mediastinal tumors and cysts, and how many days patients need to stay in the hospital after surgery.
What is the Mediastinum?
The mediastinum is the area inside the chest cavity, bordered in the front by the back of the breastbone, in the back by the spine, and in the sides by the lungs. This area contains the heart, major blood vessels, lymph node stations, and nerve structures. Due to the wide variety of tissues in this area, many different types of tumors and cysts can be seen.
What are Mediastinal Tumors?
Some mediastinal tumors are benign, while others are malignant. They often cause symptoms by pressing on nearby blood vessels, the trachea, or nerve structures. The most common tumors include thymomas, nerve sheath tumors, and lymphomas. Other rare tumors that can occur include germ cell tumors, lymphoma, hamartomas, thymic carcinoid, thymic carcinomas, teratomas, neuroblastomas, and sarcoidosis. In some cases, thyroid tissue may grow and extend into the mediastinum.
THYMOMA
Thymomas are the most common tumors found in the anterior mediastinum. They originate from the thymus gland. Detailed information on this topic can be found on our thymoma page.
TERATOMA
These tumors, located in the anterior mediastinum, can be malignant (cancerous) or benign. Below are MRI images of a patient with a teratoma in the anterior mediastinum.
What are Mediastinal Cysts?
Bronchogenic cysts, thymic cysts, pericardial cysts, and esophageal cysts are some of the formations that can be seen. These fluid-filled formations are generally benign. Cystic formations typically do not cause significant symptoms since they do not create strong pressure. Cystic diseases should be surgically removed immediately. Tumors, on the other hand, may be surgically removed or treated with chemotherapy and/or radiotherapy, depending on whether they are benign or malignant, their relation to surrounding structures, and the patient’s overall condition. In some cases, all treatment methods may be used together.
Why is Surgery Needed for Mediastinal Cysts and Tumors?
Surgery may be required in some cases to completely remove the cyst or tumor, or it may be necessary for diagnostic purposes. Surgical intervention is needed to eliminate the conditions caused by the tumor or cyst’s pressure and to prevent the spread of a malignant tumor to other parts of the body.
What Do International Sources Recommend?
- Macchiarini P, Ostertag H (February 2004). “Uncommon primary mediastinal tumours”. Lancet Oncol. 5 (2): 107–18. doi:10.1016/S1470-2045(04)01385-3. PMID 14761815.
- Davis RD, Oldham HN, Sabiston DC (September 1987). “Primary cysts and neoplasms of the mediastinum: recent changes in clinical presentation, methods of diagnosis, management, and results”. Ann. Thorac. Surg. 44 (3): 229–37. PMID 2820323.
- Kuo TT (2001). “Classification of thymic epithelial neoplasms: a controversial issue coming to an end?”. J. Cell. Mol. Med. 5 (4): 442–8. doi:10.1111/j.1582-4934.2001.tb00182.x. PMID 12067481. https://onlinelibrary.wiley.com/doi/10.1111/j.1582-4934.2001.tb00182.x
What are the Surgical Methods for Mediastinal Tumors and Cysts?
The choice of surgery depends on the location of the tumor or cyst, whether it is benign or malignant, the patient’s age, and overall health. In most cases, one of the following two approaches is used:
1. Open Mediastinal Surgery
This method is not preferred unless necessary. In this technique, either the breastbone or the area between the ribs is opened.
2. Closed Mediastinal Surgery
- This surgery is performed without opening the chest, making it less damaging, less painful, and more comfortable for the patient.
- A small incision is made and a camera is used to perform the surgery.
- The hospital stay lasts 1-3 days.
- Pain is minimal.
- It requires special training and extensive experience.
What Are the Risks of Mediastinal Surgery?
The mediastinum is an important area, and surgeries in this region require significant surgical experience. Risks may vary depending on the presence of additional diseases, the characteristics of the tumor or cyst, and the patient’s general condition. Common risks include bleeding during the operation, nerve damage in neurogenic tumors, infection, and the need for a reoperation. All of these risks should be anticipated and appropriate precautions should be taken to minimize them.
How Many Days Should I Stay in the Hospital After Mediastinal Surgery?
On average, patients stay in the hospital for 3 days after surgery.
