Clinical Approach: Recommendations for the Clinicians

  • Fortunato Ciardiello
  • Floriana Morgillo
  • Giuseppe Viscardi
Part of the Current Clinical Pathology book series (CCPATH)


Mediastinal masses include a wide variety of entities both neoplastic and not often presenting with several clinical and pathological features thus constituting a diagnostic challenge for clinicians.

In about half of cases, a mediastinal mass can be an incidental finding in patients who undergo imaging studies for other reasons.

Local symptoms, if present, may be due to compressive or infiltrative effects of the mass, while systemic symptoms are due to release of hormones, cytokines, and antibodies. In general, malignant lesions are more likely to be symptomatic.

In most patients, a combination of demographic information, clinical presentation, and imaging features allows a presumptive diagnosis, which can be definitely addressed only after tissue biopsy.


Mediastinal Mass Superior vena cava Myasthenia gravis 


  1. 1.
    Priola AM, Priola SM, Cardinale L, et al. The anterior mediastinum: diseases. Radiol Med. 2006;111(3):312–42.CrossRefPubMedGoogle Scholar
  2. 2.
    Kim Y, Lee KS, Yoo JH, et al. Middle mediastinal lesions: imaging findings and pathologic correlation. Eur J Radiol. 2000;35(1):30–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Occhipinti M, Heidinger BH, Franquet E, et al. Imaging the posterior mediastinum: a multimodality approach. Diagn Interv Radiol. 2015;21(4):293–306.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Athanassiadi KA. Infections of mediastinum. Thorac Surg Clin. 2009;19(1):37–45.CrossRefPubMedGoogle Scholar
  5. 5.
    Davis RD Jr, Oldham HN Jr, Sabiston DC Jr. Primary cysts and neoplasms of the mediastinum: recent changes in clinical presentation, methods of diagnosis, management, and results. Ann Thorac Surg. 1987;44(3):229–37.CrossRefPubMedGoogle Scholar
  6. 6.
    Wilson LD, Detterbeck FC, Yahalom J. Superior vena cava syndrome with malignant causes. N Engl J Med. 2007;356:1862–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Cohen R, Mena D, Carbajal-Mendoza R, et al. Superior vena cava syndrome: a medical emergency? Int J Angiol. 2008;17(1):43–6.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Shelly S, Levin NA, Altman A, et al. Thymoma and autoimmunity. Cell Mol Immunol. 2011;8(3):199–202.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Azarow KS, Pearl RH, Zurcher R, et al. Primary mediastinal masses: a comparison of adult and pediatric populations. J Thorac Cardiovasc Surg. 1993;106:67.PubMedGoogle Scholar
  10. 10.
    Barlow LJ, Badalato GM, McKiernan JM. Serum tumor markers in the evaluation of male germ cell tumors. Nat Rev Urol. 2010;7(11):610–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Takahashi K, Al-Janabi NJ. Computed tomography and magnetic resonance imaging of mediastinal tumors. J Magn Reson Imaging. 2010;32(6):1325–39.CrossRefPubMedGoogle Scholar
  12. 12.
    Gupta S, Seaberg K, Wallace MJ, et al. Imaging-guided percutaneous biopsy of mediastinal lesions: different approaches and anatomic considerations. Radiographics. 2005;25(3):763–86.CrossRefPubMedGoogle Scholar
  13. 13.
    Strickler JG, Kurtin PJ. Mediastinal lymphoma. Semin Diagn Pathol. 1991;8:2–13.PubMedGoogle Scholar
  14. 14.
    Herrada J, Cabanillas F, Rice L, et al. The clinical behavior of localized and multicentric Castleman disease. Ann Intern Med. 1998;128(8):657–62.CrossRefPubMedGoogle Scholar
  15. 15.
    Takeda S, Miyoshi S, Minami M, et al. Clinical spectrum of mediastinal cysts. Chest. 2003;124:125–32.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Duwe BV, Sterman DH, Musani AI. Tumors of the mediastinum. Chest. 2005;128(4):2893–909.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Hainsworth J. Diagnosis, staging, and clinical characteristics of the patient with mediastinal germ cell carcinoma. Chest Surg Clin N Am. 2002;12:665–72.CrossRefPubMedGoogle Scholar
  18. 18.
    Reeder LB. Neurogenic tumors of the mediastinum. Semin Thorac Cardiovasc Surg. 2000;12(4):261–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Fortunato Ciardiello
    • 1
  • Floriana Morgillo
    • 1
  • Giuseppe Viscardi
    • 1
  1. 1.Oncology Unit, Department of Precision MedicineUniversità della Campania “L. Vanvitelli”NaplesItaly

Personalised recommendations