Debarati Pathak1, Abhijit Banerjee2, Soma Ghosh3, Arghya Bandyopadhyay4, Tushar Kanti Das5
BACKGROUND
Mediastinal masses, an enigma to surgical pathologist are among the most
complicated lesions explored and relatively inaccessible. They often connote a
process with mass effect presenting with superior mediastinal syndrome. This is a
challenging area faced by surgical pathologist as varied lesions are found here and
often biopsies obtained are tiny and crushed. Appropriate therapy of various
mediastinal tumours differs considerably and may significantly impact survival. We
wanted to evaluate the various lesions in different compartments of mediastinum
and categorise them according to anatomical location, and histopathology.
METHODS
Patients with mediastinal masses attending outpatient department were selected,
history taken and relevant investigations done with radiological evaluation for
proper anatomical location of lesion. Histopathological study done on tissues
obtained by ultrasound / CT guided biopsy, open surgical biopsy were categorized
according to histologic types. Immunohistochemistry was done wherever
applicable.
RESULTS
A total of 58 cases of mediastinal lesions were studied where males predominated
and age of patients ranged from 11 months to 68 yrs. All patients were
symptomatic. Shortness of breath, superior vena cava syndrome was dominant in
anterior and superior mediastinal lesions, middle and posterior mediastinal masses
presented with chest pain. Most lesions were neoplastic. Germ cell tumours were
found in (24.14 %) followed by lymphoma in (20.69 %) and thymic lesions in
(18.97 %) of patients. Neurogenic tumours found in (13.79 %) were located in
posterior mediastinum whereas, germ cell tumours and lymphomas were located
in anterior mediastinum. Non neoplastic lesions included tuberculosis, sarcoidosis.
Unsuspected lesion was metastatic deposit of adenoid cystic carcinoma.
CONCLUSIONS
A wide variety of non-neoplastic and neoplastic lesions can be found in different
compartments of mediastinum and accurate diagnosis is considered necessary to
formulate management strategies.
