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Metastatic germ cell tumor of the mediastinum. Axial CT in an 18-year-old boy shows a large prevascular mass and lung metastases (arrow). Biopsy revealed malignant mixed germ cell tumor with predominant choriocarcinoma components
Source publication
Mediastinal masses are categorized based on the International Thymic Malignancy Interest Group (ITMIG) classification into prevascular, visceral and paravertebral compartments. The schema is based on cross-sectional imaging, mainly CT, and helps with generating a differential diagnosis based on location of the mass. Up to half of all pediatric medi...
Citations
... However, to our knowledge, our study is the first to combine SUVmax with clinical parameters and includes the largest sample used to investigate the differentiation of primary mediastinal lymphomas from TETs in anterior mediastinal masses. Primary mediastinal lymphoma usually occurs in the anterior mediastinum, and lymphoma accounts for nearly 20% of all mediastinum neoplasms in adults and 50% in children (17). The discrimination of lymphoma and TETs is difficult due their associated low CT and MRI diagnostic efficiency and a lack of specific tumor markers (18,19). ...
Background
Anterior mediastinal masses are relatively uncommon, and mediastinal lymphomas are the malignancies most likely to be confused with thymic epithelial tumors (TETs). The aim of this study was to investigate whether the combination of ¹⁸fluorine-fluorodeoxyglucose positron emission tomography-computed tomography (¹⁸F-FDG PET-CT) findings and clinical parameters is useful in differentiating lymphoma from TETs in anterior mediastinal masses.
Methods
This retrospective study consecutively included 304 patients with anterior mediastinal masses (244 TETs and 60 lymphomas) who underwent ¹⁸F-FDG PET-CT 1 to 2 weeks before tumor resection or biopsy between August 2016 and March 2022. The correlations between the maximum standardized uptake value (SUVmax) of tumors and clinical parameters of patients with histology subtypes were analyzed. Receiver operating characteristic curve analysis was used to obtain the optimal cutoff values of age, lactate dehydrogenase (LDH), tumor size, and SUVmax to predict lymphoma. Logistic regression analysis was used to identify potential predictive factors for lymphoma.
Results
Lymphoma was significantly associated with younger patient age, higher LDH level, larger tumor size, and higher SUVmax compared to TETs (P<0.001). In the modeling cohort, age ≤40.5 years, LDH level ≥197 U/L, tumor size ≥10.72 cm, and SUVmax ≥11.95 were identified as independent predictors for lymphoma with odds ratios of 20.14 [95% confidence interval (CI): 6.02–67.40; P<0.001], 4.89 (95% CI: 1.27–18.89; P=0.021), 8.82 (95% CI: 2.31–33.69; P=0.001), and 30.01 (95% CI: 6.59–136.72; P<0.001), respectively. The accuracy of age, LDH, tumor size, and SUVmax in predicting lymphoma was 84.8%, 67.8%, 85.2%, and 78.3% respectively. The combination of the four above parameters could improve the predictive accuracy to 89.1%, and in the validation cohort, this combination increased the predictive accuracy to 87.8%.
Conclusions
SUVmax on ¹⁸F-FDG PET-CT has the potential ability to discriminate lymphomas from TETs in the diagnosis of anterior mediastinal masses, and the combination of SUVmax with clinical parameters can improve the diagnostic accuracy. This combination may therefore may be helpful in avoiding unnecessary operation in patients with anterior mediastinal lymphomas.
The Risser classification is a system which grades skeletal maturity based upon the degree of fusion of the iliac crest apophyses. This can be used as a surrogate marker for skeletal maturity and the ossification of the vertebrae which generally parallels that of the iliac crest. The higher the Risser grade, the greater the skeletal maturity. As such, this can be used to predict the progression of scoliosis based on the amount of skeletal maturation that remains and may be used when planning corrective spinal surgery.
Objectives
Mediastinal cystic lymphatic malformation (MCLM) in children is prone to misdiagnosis as cystic teratoma. We compared the clinical and radiologic features between the two diseases and performed a cross-comparison with previous research focused on adult cases. This study aims to identify characteristic pediatric manifestations for the improvement of diagnostic accuracy.
Methods
We retrospectively studied clinical and radiology data of 12 cases of MCLM and 20 cases of cystic teratomas confirmed by pathology or intervention biopsy. Clinical characters and radiology features (mass location and morphology, density, component, secondary complication) were recorded and compared. We searched published clinical studies related to MCLM in the past decade. We compared the radiology differences between them. Also, a comparison was made between pediatric MCLM cases in our hospital and MCLM cases from the kinds of literature.
Results
Group comparison in pediatrics between MCLM and cystic teratomas: There were significant age differences (p = 0.036), shape (p = 0.003), DV (p < 0.001), DR (p < 0.001), calcification (p < 0.001), fat (p < 0.001), and typing (p < 0.001) between the two diseases. MCLM cases from literature: A total of 10 studies with 70 patients were eligible for data extraction.
Conclusion
The lack of internal fat or irregular morphology with minimal DV suggests the diagnosis of MCLM. In pediatric cases, anterior mediastinal diseases are more likely to extend toward the neck, and the persistence of the thymus can complicate component analysis and increase the risk of misdiagnosis. Thus, MRI evaluation is recommended for pediatric MCLM case assessment.
Background: Bronchogenic cysts result from a congenital anomalous budding of the tracheobronchial tree. Resection is usually recommended to avoid complications. Mediastinal bronchogenic cysts present a unique challenge due to their proximity to vital structures. The purpose of this study is to review our experience with mediastinal bronchogenic cysts. Methods: A single-institution retrospective review evaluated all mediastinal bronchogenic cyst excisions between January 2012 and November 2022. Patient demographics were assessed, including age at diagnosis, presenting symptoms, imaging workup, and cyst characteristics. Operative approach, complications, and surgical pathology were reported. Results: Five patients were identified. Age at diagnosis ranged from 18 to 27 months. No patient was diagnosed prenatally. All patients had symptoms at the time of diagnosis, including cough, wheezing, and respiratory distress. Three cysts were paratracheal, and two were paraesophageal. Age at surgery ranged from 26 to 30 months. All bronchogenic cysts were successfully resected thoracoscopically. Individual technical challenges included narrowing of the mainstem bronchus preventing lung isolation, significant mediastinal inflammation, the necessity for cyst evacuation to delineate the extent of the cyst, adherence of cyst wall to bronchus or trachea requiring cold dissection, and a stalk of tissue with an intimate connection to the carina that was amputated. No intraoperative or postoperative complication occurred. Surgical pathology was consistent with a bronchogenic cyst in all cases. Median length of hospital stay was two days. Conclusion: Thoracoscopy is a safe and effective procedure for mediastinal bronchogenic cyst excision in children. Certain technical maneuvers are highlighted, which may facilitate resection.
