Advertisement

Imaging of Mediastinal Tumors

  • Brett W. CarterEmail author
  • Edith M. Marom
Chapter

Abstract

Mediastinal masses include a wide variety of histopathologic entities of neoplastic, congenital, vascular, and lymphatic origin. As mediastinal lesions are relatively uncommon, many radiologists, pathologists, and other healthcare providers will only encounter many of these abnormalities infrequently. Imaging plays a critical role in the identification and assessment of mediastinal lesions, enabling formulation of a focused differential diagnosis and ultimately guiding further clinical management. In some instances, imaging features of mediastinal masses may be identified on cross-sectional imaging techniques such as computed tomography and magnetic resonance imaging that suggest a specific diagnosis. In other cases, a combination of imaging, pathological, and clinical information is necessary to narrow the differential diagnosis and guide management. In this chapter, we present the imaging features of key mediastinal lesions that radiologists and other healthcare providers will likely encounter in clinical practice.

Keywords

Mediastinum Neoplasms Tumors Radiography Computed tomography Magnetic resonance imaging Positron emission tomography/computed tomography 

References

  1. 1.
    Carter BW, Tomiyama N, Bhora FY, Rosado de Christenson ML, Nakajima J, Boiselle PM, et al. A modern definition of mediastinal compartments. J Thorac Oncol. 2014;9(9 Suppl 2):S97–101.CrossRefGoogle Scholar
  2. 2.
    Carter BW, Benveniste MF, Madan R, Godoy MC, de Groot PM, Truong MT, Rosado-de-Christenson ML, Marom EM. ITMIG classification of mediastinal compartments and multidisciplinary approach to mediastinal masses. Radiographics. 2017;37(2):413–36.CrossRefGoogle Scholar
  3. 3.
    Fujimoto K, Hara M, Tomiyama N, Kusumoto M, Sakai F, Fujii Y. Proposal for a new mediastinal compartment classification of transverse plane images according to the Japanese Association for Research on the Thymus (JART) General Rules for the Study of Mediastinal Tumors. Oncol Rep. 2014;31:565–72.CrossRefGoogle Scholar
  4. 4.
    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;44:229–37.CrossRefGoogle Scholar
  5. 5.
    Levasseur P, Kaswin R, Rojas-Miranda A, N'guimbous JF, Merlier M, Le Brigand H. Apropos of a series of 742 operated patients. Nouv Press Med. 1976;5:2857–9.Google Scholar
  6. 6.
    Cohen AJ, Thompson L, Edwards FH, Bellamy RF. Primary cysts and tumors of the mediastinum. Ann Thorac Surg. 1991;51:378–84; discussion 385.CrossRefGoogle Scholar
  7. 7.
    Rubush JL, Gardner IR, Boyd WC, Ehrenhaft JL. Mediastinal tumors. Review of 186 cases. J Thorac Cardiovasc Surg. 1973;65:216–22.PubMedGoogle Scholar
  8. 8.
    Wychulis AR, Payne WS, Clagett OT, Woolner LB. Surgical treatment of mediastinal tumors: a 40 year experience. J Thorac Cardiovasc Surg. 1971;62:379–92.PubMedGoogle Scholar
  9. 9.
    Mullen B, Richardson JD. Primary anterior mediastinal tumors in children and adults. Ann Thorac Surg. 1986;42:338–45.CrossRefGoogle Scholar
  10. 10.
    Takeda S, Miyoshi S, Minami M, Ohta M, Minami M, Okumura M, et al. Clinical spectrum of primary mediastinal tumors: a comparison of adult and pediatric populations (Abstract). Chest. 2000;118:206S.Google Scholar
  11. 11.
    Whooley BP, Urschel JD, Antkowiak JG, Takita H. Primary tumors of the mediastinum. J Surg Oncol. 1999;70:95–9.CrossRefGoogle Scholar
  12. 12.
    Azarow KS, Pearl RH, Zurcher R, Edwards FH, Cohen AJ. Primary mediastinal masses. A comparison of adult and pediatric populations. J Thorac Cardiovasc Surg. 1993;106:67–72.PubMedGoogle Scholar
  13. 13.
    Carter BW, Okumura M, Detterbeck FC, Marom EM. Approaching the patient with an anterior mediastinal mass: a guide for radiologists. J Thorac Oncol. 2014;9(9 Suppl 2):S110–8.13.CrossRefGoogle Scholar
  14. 14.
    Tomiyama N, Honda O, Tsubamoto M, Inoue A, Sumikawa H, Kuriyama K, et al. Anterior mediastinal tumors: diagnostic accuracy of CT and MRI. Eur J Radiol. 2009;69:280–8.CrossRefGoogle Scholar
  15. 15.
    Ackman JB, Wu CC. MRI of the thymus. AJR Am J Roentgenol. 2011;197:W15–20.CrossRefGoogle Scholar
  16. 16.
    Inaoka T, Takahashi K, Mineta M, Yamada T, Shuke N, Okizaki A, et al. Thymic hyperplasia and thymus gland tumors: differentiation with chemical shift MR imaging. Radiology. 2007;243:869–76.CrossRefGoogle Scholar
  17. 17.
    Takahashi K, Al-Janabi NJ. Computed tomography and magnetic resonance imaging of mediastinal tumors. J Magn Reson Imaging. 2010;32:1325–39.CrossRefGoogle Scholar
  18. 18.
    Rosado-de-Christenson ML, Templeton PA, Moran CA. From the archives of the AFIP. Mediastinal germ cell tumors: radiologic and pathologic correlation. Radiographics. 1992;12:1013–30.CrossRefGoogle Scholar
  19. 19.
    Molinari F, Bankier AA, Eisenberg RL. Fat-containing lesions in adult thoracic imaging. AJR Am J Roentgenol. 2011;197:W795–813.CrossRefGoogle Scholar
  20. 20.
    Wright C. Germ cell tumors of the mediastinum. In: Pearson F, Cooper J, Deslauriers J, Ginsberg RJ, Hiebert C, Patterson G, Urschel H, editors. Thoracic Surgery. New York: Churchill Livingstone; 2002. p. 1711–9.Google Scholar
  21. 21.
    Gaerte SC, Meyer CA, Winer-Muram HT, Tarver RD, Conces DJ Jr. Fat-containing lesions of the chest. Radiographics. 2002;22:S61–78.CrossRefGoogle Scholar
  22. 22.
    Nishino M, Ashiku SK, Kocher ON, Thurer RL, Boiselle PM, Hatabu H. The thymus: a comprehensive review. Radiographics. 2006;26:335–48.CrossRefGoogle Scholar
  23. 23.
    Munden RF, Nesbitt JC, Kemp BL, Chasen MH, Whitman GJ. Primary liposarcoma of the mediastinum. AJR Am J Roentgenol. 2000;175:1340.CrossRefGoogle Scholar
  24. 24.
    Hahn HP, Fletcher CD. Primary mediastinal liposarcoma: clinicopathologic analysis of 24 cases. Am J Surg Pathol. 2007;31:1868–74.CrossRefGoogle Scholar
  25. 25.
    Choi YW, McAdams HP, Jeon SC, Hong EK, Kim YH, Im JG, et al. Idiopathic multilocular thymic cyst: CT features with clinical and histopathologic correlation. AJR Am J Roentgenol. 2001;177:881–5.CrossRefGoogle Scholar
  26. 26.
    Jeung MY, Gasser B, Gangi A, Bogorin A, Charneau D, Wihlm JM, et al. Imaging of cystic masses of the mediastinum. Radiographics. 2002;22:S79–93.CrossRefGoogle Scholar
  27. 27.
    Feigin DS, Fenoglio JJ, McAllister HA, Madewell JE. Pericardial cysts. A radiologic-pathologic correlation and review. Radiology. 1977;125:15–20.CrossRefGoogle Scholar
  28. 28.
    Mendelson DS, Rose JS, Efremidis SC, Kirschner PA, Cohen BA. Bronchogenic cysts with high CT numbers. AJR Am J Roentgenol. 1983;140:463–5.CrossRefGoogle Scholar
  29. 29.
    Yernault JC, Kuhn G, Dumortier P, Rocmans P, Ketelbant P, De Vuyst P. “Solid” mediastinal bronchogenic cyst: mineralogic analysis. AJR Am J Roentgenol. 1986;146:73–4.CrossRefGoogle Scholar
  30. 30.
    Fitch SJ, Tonkin IL, Tonkin AK. Imaging of foregut duplication cysts. Radiographics. 1986;6:189–201.CrossRefGoogle Scholar
  31. 31.
    Kuhlman JE, Fishman EK, Wang KP, Siegelman SS. Esophageal duplication cyst: CT and transesophageal needle aspiration. AJR Am J Roentgenol. 1985;145:531–2.CrossRefGoogle Scholar
  32. 32.
    LeBlanc J, Guttentag AR, Shepard JA, McLoud TC. Imaging of mediastinal foregut cysts. Can Assoc Radiol J. 1994;45:381–6.PubMedGoogle Scholar
  33. 33.
    Naidich DP, Webb WR, Muller NL, Krinsky GA, Zerhouni EA, Siegelman SS. Mediastinum. In: Computed tomography and magnetic resonance of the thorax. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 1999. p. 82–3.Google Scholar
  34. 34.
    Benveniste MF, Rosado-de-Christenson ML, Sabloff BS, Moran CA, Swisher SG, Marom EM. Role of imaging in the diagnosis, staging, and treatment of thymoma. Radiographics. 2011;31:1847–61; discussion 1861.CrossRefGoogle Scholar
  35. 35.
    Rosado-de-Christenson ML, Strollo DC, Marom EM. Imaging of thymic epithelial neoplasms. Hematol Oncol Clin North Am. 2008;22(3):409–31.CrossRefGoogle Scholar
  36. 36.
    Schaefer NG, Hany TF, Taverna C, Seifert B, Stumpe KD, von Schulthess GK, et al. Non-Hodgkin lymphoma and Hodgkin disease: coregistered FDG PET and CT at staging and restaging–do we need contrast-enhanced CT? Radiology. 2004;232:823–9.CrossRefGoogle Scholar
  37. 37.
    Duwe BV, Sterman DH, Musani AI. Tumors of the mediastinum. Chest. 2005;128(4):2893–909.CrossRefGoogle Scholar
  38. 38.
    Tian L, Liu LZ, Cui CY, Zhang WD, Kuang YL. CT findings of primary non-teratomatous germ cell tumors of the mediastinum--a report of 15 cases. Eur J Radiol. 2012;81(5):1057–61.CrossRefGoogle Scholar
  39. 39.
    Strollo DC, Rosado-de-Christenson ML. Primary mediastinal malignant germ cell neoplasms: imaging features. Chest Surg Clin N Am. 2002;12:645–58.CrossRefGoogle Scholar
  40. 40.
    Economou JS, Trump DL, Holmes EC, Eggleston JE. Management of primary germ cell tumors of the mediastinum. J Thorac Cardiovasc Surg. 1982;83:643–9.PubMedGoogle Scholar
  41. 41.
    Bokemeyer C, Nichols CR, Droz JP, Schmoll HJ, Horwich A, Gerl A, et al. Extragonadal germ cell tumors of the mediastinum and retroperitoneum: results from an international analysis. J Clin Oncol. 2002;20:1864–73.CrossRefGoogle Scholar
  42. 42.
    Bukowski RM, Wolf M, Kulander BG, Montie J, Crawford ED, Blumenstein B. Alternating combination chemotherapy in patients with extragonadal germ cell tumors. A Southwest Oncology Group study. Cancer. 1993;71:2631–8.CrossRefGoogle Scholar
  43. 43.
    Lee KS, Lm J-G, Han CH, Han MC, Kim C-W, Kim WS. Malignant primary germ cell tumors of the mediastinum: CT features. AJR. 1989;153:947–51.CrossRefGoogle Scholar
  44. 44.
    Wright CD, Kesler KA, Nichols CR, Mahomed Y, Einhorn LH, Miller ME, et al. Primary mediastinal nonseminomatous germ cell tumors. Results of a multimodality approach. J Thorac Cardiovasc Surg. 1990;99:210–7.PubMedGoogle Scholar
  45. 45.
    Kesler KA, Rieger KM, Ganjoo KN, Sharma M, Fineberg NS, Einhorn LH, et al. Primary mediastinal nonseminomatous germ cell tumors: the influence of postchemotherapy pathology on long-term survival after surgery. J Thorac Cardiovasc Surg. 1999;118:692–700.CrossRefGoogle Scholar
  46. 46.
    Hong SJ, Kim TJ, Nam KB, Lee IS, Yang HC, Cho S, et al. New TNM staging system for esophageal cancer: what chest radiologists need to know. Radiographics. 2014;34(6):1722–40.CrossRefGoogle Scholar
  47. 47.
    Nakazono T, White CS, Yamasaki F, Yamaguchi K, Egashira R, Irie H, et al. MRI findings of mediastinal neurogenic tumors. AJR Am J Roentgenol. 2011;197:W643–52.CrossRefGoogle Scholar
  48. 48.
    Juanpere S, Cañete N, Ortuño P, Martínez S, Sanchez G, Bernado L. A diagnostic approach to the mediastinal masses. Insights Imaging. 2013;4:29–52.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.The University of Texas MD Anderson Cancer Center, Department of Diagnostic RadiologyHoustonUSA
  2. 2.The Tel Aviv University, Sackler School of Medicine, Department of Diagnostic ImagingTel AvivIsrael
  3. 3.Thoracic Imaging Section, The Chaim Sheba Medical Center, Department of Diagnostic RadiologyRamat GanIsrael

Personalised recommendations