Pathology of mediastinal tumors
- Henry D Tazelaar, MD
Henry D Tazelaar, MD
- Mayo Clinic Arizona
- Professor of Pathology
- Mayo Clinic College of Medicine
- Chair of the Department of Laboratory Medicine and Pathology
- Mayo Clinic Arizona
- William D Travis, MD
William D Travis, MD
- Adjunct Professor of Pathology
- Weill Medical College - Cornell University
- Section Editors
- Andrew Nicholson, MD
Andrew Nicholson, MD
- Section Editor — Pulmonary Pathology
- Professor of Respiratory Pathology
- Imperial College School of Medicine, London
- James R Jett, MD
James R Jett, MD
- Section Editor — Lung Cancer
- Professor of Medicine Emeritus
- National Jewish Health
- Rogerio C Lilenbaum, MD, FACP
Rogerio C Lilenbaum, MD, FACP
- Section Editor — Lung Cancer
- Yale Cancer Center
Mediastinal tumors are among the most difficult lesions examined by the surgical pathologist for several reasons. First, many different types of lesions occur in this location (figure 1 and figure 2). Second, biopsies often consist of small, crushed specimens. Third, few pathologists have significant experience with mediastinal pathology because specimens from this location are relatively uncommon.
Since many tumors that occur in the mediastinum are undifferentiated and have overlapping histologic features, one must consider a broad differential diagnosis and perform a thorough evaluation of each biopsy specimen. This is particularly important since appropriate therapy for various mediastinal tumors differs considerably and may significantly impact survival. Additionally, it may not be apparent whether the tumor actually arises in the mediastinum or from adjacent lung.
The pathology of mediastinal tumors is reviewed here. The clinical evaluation of mediastinal masses is discussed elsewhere, and clinical and management issues of the specific tumor types are reviewed in the relevant topics. (See "Approach to the adult patient with a mediastinal mass".)
EXAMINATION OF SPECIMENS
One of the most difficult problems in the diagnosis of mediastinal tumors can be obtaining an adequate biopsy specimen. As some mediastinal tumors are not treated surgically (eg, lymphoma), diagnosis is often attempted with needle core or minimally invasive surgical biopsies. Biopsies may be non-diagnostic because the lesion is not sampled adequately or because crush artifact or extensive necrosis, fibrosis, or cystic change obscures the diagnostic lesion. (See "Approach to the adult patient with a mediastinal mass".)
Intraoperative frozen sections are often used in the setting of surgical procedures:
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- EXAMINATION OF SPECIMENS
- Gross features
- Prognosis and treatment
- THYMIC CARCINOMA
- Gross appearance
- Differential diagnosis
- Prognostic implications
- THYMIC NEUROENDOCRINE TUMORS
- GERM CELL TUMORS
- Histologic subtypes
- - Mature teratoma
- - Immature teratomas
- - Seminomas
- - Nonseminomatous GCTs
- NEUROGENIC TUMORS
- MESENCHYMAL TUMORS