Middle mediastinal masses include all of the following except:
|B||Ascending aortic aneurysm|
a. Neurogenic tumors are the most common neoplasm, constituting 23% of all primary tumors and cysts.
b. These tumors are usually located in the posterior mediastinum and originate from the sympathetic ganglia (ganglioma, ganglioneuroblastoma, and neuroblastoma), the intercostal nerves (neurofibroma, neurilemoma, and neurosarcoma), and the paraganglia cells (paraganglioma).
c. Only rarely are neurogenic tumors located in the anterosuperior mediastinum.
d. Most neurogenic tumors in adults are benign but a greater percentage of neurogenic tumors are malignant in children.
e. Many of these tumors are found on routine chest radiographs in patients who do not have symptoms.
f. When present, symptoms are usually caused by mechanical factors, such as chest and back pain resulting from compression or invasion of intercostal nerve, bone, and chest wall; cough and dyspnea resulting from compression of the tracheobronchial tree; Pancoast's syndrome; and Horner's syndrome resulting from involvement of the brachial and the cervical sympathetic chain. Symptoms may be systemic and related to production of neurohormonal agents.
g. Thoracoscopy has played an increasing role in both diagnosis and treatment of neurogenic tumors .
h. Benign neurogenic tumors are particularly amenable to thoracoscopic removal, and more rapid postoperative recovery is seen with thoracoscopic removal than with open excision.
i. For malignant tumors, the standard of care remains thoracotomy.