Hintergrund The International Thymic Malignancy Interest Group (ITMIG)
proposed an internationally accepted division of the mediastinum into three
compartments based on CT: anterior (prevascular), middle (visceral) and posterior
(paravertebral) compartment. There is no generally accepted definition for the term
“giant” when applied to middle mediastinal tumors. We defined the
term “giant” and described our surgical experience in treating
patients with giant tumors of the middle mediastinum.
Material und Methode CT imaging of patients operated in our centre
from January 2016 to August 2021 for mediastinal tumors was reviewed. Tumors were
categorized to one of the ITMIG-defined compartments. Tumor size at diagnosis was
measured at its largest diameter on axial CT imaging. Giant middle mediastinal
tumors were defined as tumors having a size ≥90th percentile of our middle
mediastinal tumor cohort. Patients with giant middle mediastinal tumors were further
analysed.
Ergebnis Thirty-six patients (23%) had tumors located in the
middle mediastinal compartment. Most common diagnoses were mediastinal cysts
(n=10, 28%), metastatic lesions (n=6, 17%),
lymphomas (n=5, 14%), and sarcomas (n=3, 8%).
Ninetieth percentile tumor size was 73mm. As per definition, four patients had giant
middle mediastinal tumors. All these four tumors were of mesenchymal origin
including oesophageal leiomyoma, synovial sarcoma, leiomyosarcoma and
undifferentiated round cell sarcoma. Resection was performed through posterolateral
thoracotomy or sternotomy, with or without cardiopulmonary bypass.
Schlussfolgerung The term “giant” could be defined as
a mass larger or equal to 73mm. This definition selected specifically tumors with
mesenchymal origin. Preoperative histopathological diagnosis is still warranted to
guide further management.
