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Dermoid (Mediastinal)

  1. Dermoid cysts arise from ectodermal tissue, whereas teratomas are germ cell tumours that contain ectodermal, mesodermal and endodermal tissue.
  2. These teratodermoid tumours occur in the mediastinum mainly in 20 to 30 year age group, most often in the anterior mediastinum.Q
  3. In general, dermoids are cystic and benign, whereas teratomas are solid and malignant.Q
  1. Management
    1. Thoracotomy may be considered for diagnosis and removal
    2. Radiotherapy may may achieve long-term control in malignant teratoma  
  2. Germ cell tumours of the mediastinum
    1. 25% of anterior compartment mediastinal tumours are of germ cell origin and fall into three groups: benign teratoma, malgnant seminoma and nonseminomatous malignant germ cell tumours.
    2. They are due to primary tumours arising from residual germ cells which have migrated along the embryonic urogenital ridge. Q
    3. The malignant germ cell tumours, have a preponderance in males and are associated with chromosomal abnormalities such as Klinefelter’s syndrome and other blood dyscrasias.
    4. Benign teratomas are cured by complete surgical excision.
    5. Seminomas are very radiosensitive and radiotherapy is the mainstay of treatment.
    6. Bulky tumours may respond to induction therapy with cisplatin, bleomycin and etoposide before radiotherapy. Q
    7. Non seminomatous tumours cisplatin based chemotherapy can produce complete remission in over 50% of cases.
    8. Surgery is indicated for residual disease in the mediastinum or for lung metastases if serum tumour markers have reverted to normal.  

Mediastinal Tumors in Adults

Tumor Type

Percentage of Total

Location

Neurogenic tumors

21

Posterior

Cysts

20

All

Thymomas

19

Anterior

Lymphomas

13

Anterior/middle

Germ cell tumors

11

Anterior

Mesenchymal tumors

7

All

Endocrine tumors

6

Anterior/middle


 

Mediastinal Tumors in Children

Tumor Type

Percentage of Total

Location

Neurogenic tumors

40Q

Posterior

Lymphomas

18

Anterior/middle

Cysts

18

All

Germ cell tumors

11

Anterior

Mesenchymal tumors

9

All

Thymomas

Rare

Anterior

 

In adults, the most common tumors include neurogenic tumors of the posterior compartment, benign cysts occurring in any compartment, and thymomas of the anterior mediastinum. In children, neurogenic tumors of the posterior mediastinum are also common. Lymphoma is the second most common mediastinal tumor, usually located in the anterior or middle compartment, and thymoma is rare. In both age groups, approximately 25% of mediastinal tumors are malignant.

 

Ref: Schwartz's Principles of Surgery 9th Edition Ch 19





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