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A 64-year-old man with widely invasive thymoma (WHO B1). (a) Contrast-enhanced axial CT image shows an irregular mass (asterisk) in the right anterior mediastinum with infiltration of the mediastinal fat (white arrow). The mass (asterisk) is isointense on the axial T1W image (b), heterogeneously hyperintense on the T2W image (c) and shows delayed heterogeneous enhancement on the post-gadolinium T1W-fat saturated MR images (d).
Source publication
Anterior mediastinal tumours include primary and secondary tumours. Patients may be asymptomatic or present with symptoms related to local tumour invasion or systemic symptoms due to release of hormones/cytokines or antibodies. The most common symptoms at presentation include chest pain, dyspnoea, cough, fever and chills. Despite rapid developments...
Context in source publication
Context 1
... thymomas usually have smooth contours, sep- tation, complete or near-complete capsules and homoge- neous enhancement [16] . High-risk thymomas and thymic carcinomas commonly have lobulated contours, mediast- inal fat and great vessel invasion. Heterogeneous signal on T2W images are more common in invasive forms (Fig. 3) [3] . Irregular contour, necrotic or cystic compo- nents, heterogeneous enhancement, lymphadenopathy and great vessel invasion suggest thymic carcinomas [16] . Findings associated with more frequent recurrences and metastases include lobulated/irregular contours, oval shape, mediastinal fat or great vessel invasion and pleural seeding ...
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Citations
... Many anatomists further divide it into posterior, anterior, and middle compartments. About 50% of all mediastinal masses, including teratoma, thymoma, lymphoma, and thyroid illness, are anterior mediastinal tumors [2,3]. Thymoma, lymphoma, and germ cell cancers like seminoma, teratoma, and yolk sac tumors all can cause a mass in the anterior mediastinum. ...
Introduction
The phrase “mediastinal mass” refers to a mass within the mediastinum. About 50% of all mediastinal masses, including teratoma, thymoma, lymphoma, and thyroid illness, are anterior mediastinal tumors. Data on the mediastinal mass in India are relatively sparse, especially in this region, compared to those from other countries. Mediastinal masses are very infrequent lesions that might occasionally present a diagnostic and therapeutic challenge to the doctor. The current study describes the socio-demographic characteristics, symptoms, diagnosis, and location of mediastinal mass among the study participants.
Methodology
We carried out a retrospective, cross-sectional study in a tertiary care center in Chennai for three years. We included patients with an age above 16 years who visited the tertiary care center in Chennai during the study period. We included all patients with a mediastinal mass diagnosed by CT scan, with or without signs and symptoms of mediastinal compression. Patients under the age of 16 and those with insufficient data were both excluded from the study. As per the universal sampling technique, we included all the patients who met the eligibility criteria during the study period (three years) as study subjects. By using the hospital records, we collected all data about the patients like socio-demographic data, presenting complaints, past history, x-ray findings, and co-morbidities. Similarly, we recorded blood parameters, pleural fluid parameters, and histopathological reports from the laboratory register.
Results
The mean age of the study participants was 41.11 years, with a high proportion of patients belonging to the age group of 21 to 30 years. Over 70% of the study participants were male. Only about 54.5% of the study participants had symptoms because of a mediastinal mass. The most common local symptom felt by the patients was dyspnea, followed by a dry cough. Weight loss was the most common symptom for the patients. Most study participants (47.7%) had seen a doctor within one month of the onset of symptoms. About 4.5% of the patients had pleural effusion, as diagnosed by x-ray. Most of the study participants had a mass in the anterior mediastinum, followed by the posterior mediastinum. Most of the participants (15.9%) had non-caseating granulomatous inflammation suggestive of sarcoidosis.
Conclusion
The most common tumor found in our study was lymphoma, which was followed by non-caseating granulomatous disease and thymoma. Anterior compartments are most commonly involved. We observed the most common presentation in the third decade of life with a male to female ratio of 2:1, with dyspnea being the most common symptom, followed by a dry cough. Our study found 4.5% of the patients had pleural effusion as a complication.
... Study variables were collected from medical records, including age, sex, the presence of myasthenia gravis, and the results of clinical and pathological staging. According to the TNM staging system, clinical T stages were determined based on the morphology of TET derived from T2WI, non-contrast, and contrast-enhanced T1WI imaging as previously described [17]. Three classification systems of TET were used to determine pathological stages, including the 2015 WHO classification, the 1994 Masaoka-Koga staging system, and the 8 th edition of the TNM staging system as previously described [9]. ...
Purposes
This study aimed to evaluate the diagnostic capacity of apparent diffusion coefficient (ADC) in predicting pathological Masaoka and T stages in patients with thymic epithelial tumors (TETs).
Methods
Medical records of 62 patients who were diagnosed with TET and underwent diffusion-weighted imaging (DWI) prior to surgery between August 2017 and July 2021 were retrospectively analyzed. ADC values were calculated from DWI images using b values of 0, 400, and 800 s/mm ² . Pathological stages were determined by histological examination of surgical specimens. Cut-off points of ADC values were calculated via receiver operating characteristic (ROC) analysis.
Results
Patients had a mean age of 56.3 years. Mean ADC values were negatively correlated with pathological Masaoka and T stages. Higher values of the area under the ROC curve suggested that mean ADC values more accurately predicated pathological T stages than pathological Masaoka stages. The optimal cut-off points of mean ADC were 1.62, 1.31, and 1.48 × 10 –3 mm ² /sec for distinguishing pathological T2-T4 from pathological T1, pathological T4 from pathological T1-T3, and pathological T3-T4 from pathological T2, respectively.
Conclusion
ADC seems to more precisely predict pathological T stages, compared to pathological Masaoka stage. The cut-off values of ADC identified may be used to preoperatively predict pathological T stages of TETs.
... We can make differential diagnoses from clinical data and other imaging features. Cystic teratoma may have fat and bone components inside; substernal goiter can be determined by whether it is connected to the thyroid or very close to the enhancement pattern of the thyroid (15). ...
Objectives
This study aimed to evaluate and summarize the contrast-enhanced computed tomography (CECT) imaging features of micronodular thymoma with lymphoid stroma (MTWLS) based on all MTWLS patients at our institution and was the first imaging study of MTWLS worldwide.
Methods
This retrospective study included 10 MTWLS patients who underwent CECT between April 2012 and November 2021. We collected and analyzed the CECT imaging features, including the location, size, shape, tumor density, classification, and CT value of the solid component. Descriptive statistical analysis was performed using the SPSS software (version 26.0; IBM).
Results
Ten patients (five males [50%], five females [50%]; median age, 61.4 years; range, 54-72 years) underwent CECT. Of the 10 cases, one case was purely cystic, seven cases were cystic-solid, and two cases were purely solid. Six cases were round/oval in shape, and four cases were irregularly shaped. Excluding a purely cystic tumor with an unmeasurable degree of enhancement, two cases showed moderate enhancement, and seven cases showed significant enhancement. Among the solid or cystic-solid cases, the mean CT value of the measurable solid component on the enhanced scan was 93.9 HU. Nine masses were located adjacent to the mediastinal pleura, pericardium, or large vessels. Additionally, there were no malignant tumor signs in any patient, including penetration of the mediastinal pleura or involvement of the pericardium, pleural effusion, elevation of the diaphragm, or direct vascular invasion.
Conclusion
MTWLS demonstrates certain features on CECT, such as a high rate of cystic change, significant solid component enhancement, and no malignant, invasive imaging features. These CECT features are helpful for diagnosing MTWLS.
... Anterior mediastinal tumors account for 50% of all mediastinal masses, including thymoma, teratoma, thyroid disease, and lymphoma. 1 Masses of the middle mediastinum are typically congenital cysts, while those arising in the posterior mediastinum are often neurogenic tumors. Although conventional radiography may allow detection of or suggest the presence of a mediastinal mass, in most cases it is of limited use in determining the exact nature and extent of a lesion. ...
Background Mediastinal mass lesions span a wide histopathological and radiological spectrum. Partition of the mediastinum into specific compartments aids in differential diagnosis of mass lesions, assistance in biopsies, and other surgical procedures. Multidetector row computed tomography (MDCT) is a promising three-dimensional imaging tool allowing substantial anatomical volumes to be routinely covered with isotropic submillimeter spatial resolution to precisely localize lesions and biopsy needles for both benign and malignant disease lesions of the mediastinum.
Objective The aim of this study was to categorize mass lesions according to the mediastinal compartments to study their MDCT characteristics and to provide a comparative role of fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the diagnostic evaluation of mediastinal mass lesions.
Materials and Methods Patients with clinical or radiological suspicion of mediastinal lesions on the basis of an abnormal chest radiograph were referred to the department of radiodiagnosis at a tertiary care center between April 2015 and December 2019 for MDCT evaluation. A total of 80 cases were correlated with the histopathological diagnosis excluding aneurysms. Size, CT density (Hounsfield unit [HU] mean), and maximum standardized uptake value (SUVmax) of mediastinal and chest wall lesions were determined on FDG-PET/CT.
Results This study included a total of 102 cases, 72 males and 29 females. Mediastinal mass lesions were most common in the age group 46 to 60 years. Anterior mediastinum (n = 43, 42.2%) is the most commonly involved compartment followed by posterior mediastinum (n = 37, 35.9%) and middle mediastinum (n = 22, 21.8%). Transcompartmental involvement is more commonly seen involving the anterior and middle mediastinum. The SUVmax, HU mean, and size were higher in malignant cases (p = 0.001, p = 0.003, and p = 0.004, respectively). The current study found a cutoff value of 4.61 for SUVmax to discriminate benign lesions from malignant ones with a sensitivity and specificity of 73.7 and 75.9%, respectively (area under the curve: 0.841, 95% confidence interval: 0.793–0.965, p = 0.0001). The values of SUVmax and HU mean were higher in solid benign lesions than those of cystic benign lesions (p = 0.007 and p = 0.003, respectively).
Conclusion In the current study, MDCT has high diagnostic accuracy of ∼94% overall as compared with histopathology, and 97 and 92% for benign and malignant lesions, respectively, in the evaluation of mediastinal mass lesions. FDG-PET/CT may be complementary to conventional imaging methods for the evaluation of mediastinal and chest wall mass lesions. However, confirmatory tissue sampling is required to confirm PET positive findings for the definite diagnosis.
... Prevascular mediastinal tumors (PMTs), previously known as anterior mediastinal tumors [1], pose diagnostic challenges for clinicians because they are relatively uncommon, making up less than 1% of tumors [2], and because they include a wide variety of entities, including thymomas, benign cyst, lymphomas, and thymic carcinomas [3,4]. Patients with PMT may present chest pain, dyspnea, cough, fever, and/or chills, but many patients are asymptomatic [5]. Some types of PMTs, such as thymic or pericardial cyst, mature teratoma, thymolipoma, thymic hyperplasia, and intrathoracic goiter, have distinguishable radiological features that can be identified at CT and MR imaging [3,[6][7][8]. ...
This study aimed to build machine learning prediction models for predicting pathological subtypes of prevascular mediastinal tumors (PMTs). The candidate predictors were clinical variables and dynamic contrast–enhanced MRI (DCE-MRI)–derived perfusion parameters. The clinical data and preoperative DCE–MRI images of 62 PMT patients, including 17 patients with lymphoma, 31 with thymoma, and 14 with thymic carcinoma, were retrospectively analyzed. Six perfusion parameters were calculated as candidate predictors. Univariate receiver-operating-characteristic curve analysis was performed to evaluate the performance of the prediction models. A predictive model was built based on multi-class classification, which detected lymphoma, thymoma, and thymic carcinoma with sensitivity of 52.9%, 74.2%, and 92.8%, respectively. In addition, two predictive models were built based on binary classification for distinguishing Hodgkin from non-Hodgkin lymphoma and for distinguishing invasive from noninvasive thymoma, with sensitivity of 75% and 71.4%, respectively. In addition to two perfusion parameters (efflux rate constant from tissue extravascular extracellular space into the blood plasma, and extravascular extracellular space volume per unit volume of tissue), age and tumor volume were also essential parameters for predicting PMT subtypes. In conclusion, our machine learning–based predictive model, constructed with clinical data and perfusion parameters, may represent a useful tool for differential diagnosis of PMT subtypes.
... Nuclear magnetic resonance can also be used to identify the components of the tumor formation and evaluate the surgical resectability. The definitive diagnosis can be established only at the histopathological examination, being performed a guided biopsy [3,17,18] . In several neoplasms, vascular proliferation is found as a component of the tumor, which can be observed after chemotherapy treatment. ...
... Given the high incidence of chest diseases, the anterior mediastinal disease is an urgent medical condition. This disease includes a wide variety of illnesses (1)(2)(3)(4), the most common of which are thymoma (5,6), lymphoma, and more than 10 other illnesses (7,8). However, despite its physiological significance, anterior mediastinal disease has received little attention in medical image analysis. ...
Objectives
Anterior mediastinal disease is a common disease in the chest. Computed tomography (CT), as an important imaging technology, is widely used in the diagnosis of mediastinal diseases. Doctors find it difficult to distinguish lesions in CT images because of image artifact, intensity inhomogeneity, and their similarity with other tissues. Direct segmentation of lesions can provide doctors a method to better subtract the features of the lesions, thereby improving the accuracy of diagnosis.
Method
As the trend of image processing technology, deep learning is more accurate in image segmentation than traditional methods. We employ a two-stage 3D ResUNet network combined with lung segmentation to segment CT images. Given that the mediastinum is between the two lungs, the original image is clipped through the lung mask to remove some noises that may affect the segmentation of the lesion. To capture the feature of the lesions, we design a two-stage network structure. In the first stage, the features of the lesion are learned from the low-resolution downsampled image, and the segmentation results under a rough scale are obtained. The results are concatenated with the original image and encoded into the second stage to capture more accurate segmentation information from the image. In addition, attention gates are introduced in the upsampling of the network, and these gates can focus on the lesion and play a role in filtering the features. The proposed method has achieved good results in the segmentation of the anterior mediastinal.
Results
The proposed method was verified on 230 patients, and the anterior mediastinal lesions were well segmented. The average Dice coefficient reached 87.73%. Compared with the model without lung segmentation, the model with lung segmentation greatly improved the accuracy of lesion segmentation by approximately 9%. The addition of attention gates slightly improved the segmentation accuracy.
Conclusion
The proposed automatic segmentation method has achieved good results in clinical data. In clinical application, automatic segmentation of lesions can assist doctors in the diagnosis of diseases and may facilitate the automated diagnosis of illnesses in the future.
... Teratomas are typically located in the prevascular mediastinal compartment and contain tissues from one or more germ cell layers. They most commonly are found in younger patients and manifest as an encapsulated, welldefined lobulated mass containing a mixture of calcifications, fat, fluid, and soft tissue components [17,18]. Occasionally, teeth or fat/fluid levels may be identified. ...
Fat-containing mediastinal masses, particularly mediastinal liposarcomas, are rare neoplasms that can grow to large sizes before becoming symptomatic and may be incidentally found on radiology examinations.
In this case report, a 67-year-old male with a history of prostate cancer status post prostatectomy presented for an F-18-fluciclovine PET/CT for a rising, clinically detectable PSA and indeterminate pelvic lymph nodes seen on multiparametric MRI of the prostate. No local tumor recurrence or metastatic disease from prostate cancer was identified, but the PET/CT demonstrated a mixed soft tissue and fat density prevascular (anterior) mediastinal mass with low-level radiotracer uptake. Following surgical consultation and resection, the final pathology revealed a dedifferentiated mediastinal liposarcoma.
The case presented describes the appearance of an uncommon fat-containing mediastinal mass and describes several other fat-containing mediastinal masses that are important for radiologists to recognize in order to formulate accurate differential diagnoses and ensure appropriate further management for patients. Additionally, this case demonstrates that the radiotracer F-18-fluciclovine is not specific for prostate cancer, and its uptake can be seen with other entities such as in this case of sarcomatous malignancy.
... Germ cell tumors (GCTs) arise along the midline across from the pineal gland to the presacral area [1,2]. They form due to the incomplete migration of primitive germ cells during the early stage of embryonic development [1]. ...
... Germ cell tumors (GCTs) arise along the midline across from the pineal gland to the presacral area [1,2]. They form due to the incomplete migration of primitive germ cells during the early stage of embryonic development [1]. Most GCTs arise in a gonadal tissue; however, 50-70% of extragonadal GCTs occur in the mediastinum [1,3]. ...
... They form due to the incomplete migration of primitive germ cells during the early stage of embryonic development [1]. Most GCTs arise in a gonadal tissue; however, 50-70% of extragonadal GCTs occur in the mediastinum [1,3]. GCTs are broadly classified as either the teratomatous or nonteratomatous type [1]. ...
Germ cell tumors (GCTs) arise along the midline, in which 50-70% of extragonadal GCTs occur in the mediastinum. Malignant GCTs are more common in males, while benign GCTs occur equally in both males and females. This report presents a case of a giant primary mediastinal nonseminomatous GCT resected from a 35-year-old male who presented with dyspnoea and tightness in the chest. Thorough investigations including a chest MRI were done. It showed a 21 × 19 × 15 cm tumor. Thus, surgical resection of the tumor through a midline sternotomy was done. Histopathological analysis diagnosed the tumor as a primary mediastinal teratocarcinoma with a sarcomatous component. Eighteen-month follow-up showed no tumor recurrence. Mediastinal teratocarcinoma is a rare and life-threatening germ cell tumor. Studies recommend the use of chemotherapy prior to resection as an important step in its management. Close and regular follow-up postsurgical resection is advised.
... Low-risk thymomas commonly have smooth contours, septation, complete or near-complete capsules, and homogeneous enhancement. [6] High-risk thymomas and thymic carcinomas usually have lobulated contours, mediastinal fat and great vessel invasion. [4,6] CT features associated with more frequent recurrences and metastases include lobulated or irregular contours, oval shape, mediastinal fat or great vessel invasion, and pleural seeding. ...
... [6] High-risk thymomas and thymic carcinomas usually have lobulated contours, mediastinal fat and great vessel invasion. [4,6] CT features associated with more frequent recurrences and metastases include lobulated or irregular contours, oval shape, mediastinal fat or great vessel invasion, and pleural seeding. [6] The main differential diagnosis of thymoma in pediatric patients includes thymic hyperplasia, T-cell lymphoblastic lymphoma, and thymic carcinoma. ...
... [4,6] CT features associated with more frequent recurrences and metastases include lobulated or irregular contours, oval shape, mediastinal fat or great vessel invasion, and pleural seeding. [6] The main differential diagnosis of thymoma in pediatric patients includes thymic hyperplasia, T-cell lymphoblastic lymphoma, and thymic carcinoma. [2] Diffuse symmetric enlargement of the gland is the key imaging feature of thymic hyperplasia, whereas thymoma tends to manifest as a focal mass. ...
Thymoma is an uncommon neoplasm that derived from thymic epithelial cells. Clinically, it is slow-growing and most patients are over 40 years old. Thymoma corresponds to 30% of anterior mediastinal tumors in adults but
