CWMP - MDSTNM Flashcards by 18 22

What are the contents of the anterior compartment of the mediastinum (5)

Thymus
Internal mammary artery, vein, lymphnodes
Fat

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What are the contents of the posterior mediastinum? (5)

DEATH
D escending aorta
E sophagus
A zygos
T horacic duct
H emiazygos

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Most common mediastinal tumor in childhood

Neurogenic tumors (posterior)

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Second most common mediastinal tumor in childhood

Lymphoma (anterior, middle)

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Most common anterior mediastinal tumors in adults

Thymoma

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Most common posterior mediastinal tumors in adults

Neurogenic tumor

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True about mediastinal tumors in adults

a. 1/3 of mediastinal tumors in adults are discovered as asymptomatic abnormalities on radiologic studies
b. Even when symptomatic, the likelihood of malignancy is low
c. Mediastinal mass near the aortopulmonary window can present as hoarseness
d. AOTA
e. NOTA

C. because of compression of L laryngeal nerve

A. 2/3 of mediastinal tumors in adults are discovered as asymptomatic abnormalities
B. Symptomatic - malignant

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Germ cells tumors are found in

a. Anterior compartment
b. Visceral compartment
c. Paravertebral Sulci
d. More than one answer

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Lymphomas can be found

a. Anterior compartment
b. Visceral compartment
c. Paravertebral Sulci
d. More than one answer

D; all

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Phaeochromocytoma can be found

a. Anterior compartment
b. Visceral compartment
c. Paravertebral Sulci
d. More than one answer

D; B and C

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Hemangioma can be found

a. Anterior compartment
b. Visceral compartment
c. Paravertebral Sulci
d. More than one answer

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Most common mediastinal tumors in adults

Neurogenic tumors

2nd most common: cysts
3rd most common: thymomas

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Accuracy of FNA and core needle biopsy combined in detecting mediastinal tumors

98%

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Between FNA and Core needle biopsy, which is better at diagnosis of benign diseases?

Core needle biopsy

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Patient with dyspnea, wheezing, hemoptysis
a. Lymphoma
b. Thymoma
C. Mediastinal Granuloma
D. Gem cell tumor

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Night Sweats, weight loss, fatigue, extrathoracic adenopathy, leukocytosis
a. Lymphoma
b. Thymoma
C. Mediastinal Granuloma
D. Gem cell tumor

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Fluctuating weakness, early fatigue, ptosis, diplopia
a. Lymphoma
b. Thymoma
C. Mediastinal Granuloma
D. Gem cell tumor

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Male gender, young age, elevated hCG, AFP
a. Lymphoma
b. Thymoma
C. Mediastinal Granuloma
D. Gem cell tumor

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Patient with mediastinal tumor not amenable to endoscopic or CT-guided needle biopsy underwent surgical biopsy through sternotomy. At the time of sternotomy, the lesion was found to be easily resectable. What should be the next step?

Lesion should be completely removed.

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For anterior mediastinostomy, what procedure is ideal for an anterior tumor or a tumor with significant parasternal extension?

Chamberlain procedure

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The usual time course fo thymic hyperplasia is about

a. 8 months
b. 9 months
c. 10 months
d. 12 months

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30 y.o. male with history of chemotherapy for lymphoma with mediastinal mass on CT: triangular soft tissue density in retrosternal space with characteristic bilobed anatomic appearance with low standardized uptake. What could be the diagnosis?

Benign thymic hyperplasia

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What percentage of patients with thymoma have symptoms suggestive of myasthenia gravis?

10-50%

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What percentage of patients with myasthenia gravis have thymoma?

10%

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Thymectomy leads to resolution of symptoms of myasthenia gravis in what percentage of patients with thymomas?

25%

What percentage of patients with myasthenia gravis and no thymoma will have complete remission after thymectomy?

50%

What percentage of patients with myasthenia gravis and no thymoma will have improvement after thymectomy?

90%

True about the diagnosis of thymoma a. Imaging alone is diagnostic b. Biopsy should be avoided in cases where imaging is highly suggestive of thymoma c. Thymomas usually appear with lymphadenopathy d. AOTA e. NOTA

B a. Imaging alone is not diagnostic c. thymomas usually appear as solitary encapsulated mass while lymphadenopathy occur in lymphoma

True about thymoma EXCEPT a. it is cytologically benign and identical to early stage tumors b. also known as malignant thymoma c. there is lack of classical cellular features of malignancy d. different from thymic carcinoma

B Thymomas appear cytologically benign and identical to early stage tumors. This lack of classic cellular features of malignancy is why most pathologists use the temr thymoma or invasive thymoma rather than malignant thymoma. Tumors with malignant cytologica features are classified separately and referred to as thymic carcinoma

What is the definitive treatment for thymoma?

Complete surgical removal

What stage of thymoma is rendered non resectable?

Stage>=II

Masoaka staging system for thymoma: Gross capsular invasion or invasion into the mediastinal fat or pleura or microscopic capsular invasion

Stage II I - Encapsulated tumor with no gross or microscopic evidence of capsular invasion II - Gross capsular invasion or invasion into the mediastinal fat or pleura or microscopic capsular invasion III - Gross invasion into the pericardium, great vessels, or lung Stage IVA - Pleural or pericardial dissemination Stage IVB - Lymphogenous or hematogenous metastasis

Masoaka staging system for thymoma: Encapsulated tumor with no gross or microscopic evidence of capsular invasion

Stage I I - Encapsulated tumor with no gross or microscopic evidence of capsular invasion II - Gross capsular invasion or invasion into the mediastinal fat or pleura or microscopic capsular invasion III - Gross invasion into the pericardium, great vessels, or lung Stage IVA - Pleural or pericardial dissemination Stage IVB - Lymphogenous or hematogenous metastasis

Masaoka staging Pleural or pericardial dissemination

Stage IVA I - Encapsulated tumor with no gross or microscopic evidence of capsular invasion II - Gross capsular invasion or invasion into the mediastinal fat or pleura or microscopic capsular invasion III - Gross invasion into the pericardium, great vessels, or lung Stage IVA - Pleural or pericardial dissemination Stage IVB - Lymphogenous or hematogenous metastasis

Lymphoepithelial, small cell neuroendocrine, sarcomatoid, clear cell, and undifferentiated or anaplastic features a. Low grade thymic carcinoma b. HIgh grade thymic carcinoma

B Low grade - squamous cell, mucoepidermoid, basaloid

Benign tumors that grow to a very large size prior to diagnosis. Characteristic fat density dotted by islands of soft tissue density.

Thymolipoma

True of Neurogenic tumors EXCEPT a. The incidence, cell types, and risk of malignancy is not related to age. b. Tumors of nerve sheath origin predominate in children c. In adults, tumors of the autonomic ganglia predominate d. 2/3 of tumors in from autonomic ganglia in children and young adults are malignant

D A. related to age b. nerve sheath tumor: adults c. autonomic ganglia tumor: children and young adults

95% of nerve sheath tumors

Neurilemomas or neurofibromas

Nerve sheath tumors account for __% of mediastinal tumors

More than 95%

``` Arise from Schwann cells in intercostal nerves. 2 histologic types: Antoni Type A and Antoni Type B A. Neurofibroma B. Ganglioneuroma C. Neurilemoma D. Neuroblastoma ```

``` Both nerve sheath and nerve cells and account for up to 25% of nerve sheath tumors. 40% of these patients have von Recklinghausen's disease. 70% benign. A. Neurofibroma B. Ganglioneuroma C. Neurilemoma D. Neuroblastoma ```

Mainstay treatment of Neurofibrosarcomas

Complete surgical resection

``` Well-differentated benign tumors characterized histologically by well-differentiated ganglion cells with a background of Schwann cells. Diarrhea related to secretion of a VIP has been described in some patients. A. Schwannoma B. Ganglioneuroma C. Ganglioneuroblastoma D. Neuroblastoma ```

``` Mixture of benign ganglion cells and malignant neuroblasts. A. Schwannoma B. Ganglioneuroma C. Ganglioneuroblastoma D. Neuroblastoma ```

Most common extracranial solid malignancy of childhood

Neuroblastoma

What percentage of neuroblastoma is intrathoracic

14%

What percentage of thoracic pheochromocytomas are malignant

10%

What percentage of pheochromocytomas are located in an extra-adrenal site?

10%

Most common thoracic location of phaeochromocytomas

costovertebral sulcus

Confirmation test for phaeochromocytomas a. CT scan b. MRI c. urinary catecholamines and their metabolites d. serum catecholamines and their metabolites

Rare tumors that may be located around the aortic arch, vagus nerves, or aorticosympathetics. Rarely secrete catecholamines and are malignant in up to 30% of patients.

Chemodectomas

Most common malginancy of the mediastinum

Lymphoma

Most commonly involved mediastinal compartment in lymphoma

anterior compartment

Cure rate of early stage Hodgkin's disease with chemotherapy and/or radiation?

90%

Cure rate of advanced stage Hodgkin's disease with chemotherapy and/or radiation?

60%

Most common malignancy in young men 15-35 y.o.

Germ cell tumors

If a malignant mediastinal germ cell tumor is found, it is important to exclude primary tumor at this site

gonads

True about teratomas EXCEPT a. a.k.a. nonseminomatous germ cell tumor b. 2/3 of mediastinal germ cell tumors c. mature teratomas are benign d. high hCG and AFP levels e. NOTA

A Note: 10% of seminomatous germ cell tumor could have elevated hCG

What is the most frequent diagnostic surgical approach? for mediastinal germ cell tumors

Thoracoscopy

Mediastinal Germ cell tumor wherein most patients present with advanced disease and present with symptoms of local compression including SVC syndrome, dyspnea, or chest discomfort.

Seminomatous germ cell tumor

Embryonal cell carcinomas, chorocarcinomas, endodermal sinus tumors, mixed types. Often bulky, irregular tumors of anterior mediastinum with areas of low attenuation on CT scan because of necrosis, hemorrhage or cyst formation.

Non-seminomatous germ cell tumors

Most common type of mediastinal germ cell tumors

Teratoma

Asymptomatic, detected incidentally in the R costophrenic angle. Cyst that contain clear fluid lined with single layer of mesothelial cells.

Pericardial cyst

Management of simple, asymptomatic pericardial cyst

observation

Management of complex or large symptomatic cyst

surgical resection or aspiration

Result of abnormal budding of the foregut or tracheobronchial tree. Arise most often in the mediastinum just posterior to the carina or main stem bronchus. Contain protein rich mucoid material and varying amounts of seromucous glands, smooth muscle, and cartilage.

Bronchogenic cyst

What percentage of bronchogenic cysts are found in CXRs?

78%

Symptoms of bronchogenic cysts (4)

Chest pain Cough Dyspnea Fever

When is resection indicated for bronchogenic cyst?

large (>6cm) or symptomatic

This type of cyst should be removed regardless of the presence or absence of symptoms. Have propensity for serious complications secondary to enlargement leading to hemorrhage, infection, or perforation.

Enteric cyst

Fulminant infectious process of the mediastinum that spreads rapidly along the continuous fascial plains connecting the cervical and mediastinal compartments. U

Acute mediastinitis

Most common source of infection in acute mediastinitis (4)

esophageal perforation sternal infections oropharyngeal or neck infections

Patient with fever, chest pain, dysphagia, respiratory distress, and cervical and upper thoracic subcutaneous crepitus.

Acute mediastinitis

CWMP - MDSTNM Flashcards

(73 cards)