Treatment Options

The treatment of mediastinal cancers depends on the type of tumor and its location:

Thymoma:

  • Usually treated with resection. Earlier stage tumors need no chemotherapy or radiation. More advanced tumors are treated with preoperative treatment to shrink the tumors before an operation. If the final pathology report shows the thymoma is stage 3w, then post-op chemotherapy and radiation treatment are often recommended.
  • Surgery: Traditionally, removal of the thymoma required a median sternotomy (8-inch incision made on the front of the chest). It is the standard incision used for heart surgery. We usually do minimally invasive surgery to remove thymomas 6 cm (2.5 in) or less.

Lymphomas:

  • Are treated with chemotherapy or chemotherapy and radiation.
  • The role of surgery is to make a diagnosis by mediastinotomy or mediastinoscopy

Neurogenic tumors:

  • In the posterior (back) mediastinum are treated surgically.

Benefits of minimally invasive surgery for mediastinal tumors
Compared to open surgery, minimally invasive surgery, such as video-assisted thoracoscopy (VATS) mediastinoscopy, offers patients:

  • Decreased postoperative pain
  • Shorter hospital stay
  • More rapid recovery and return to work

Possible complications of minimally invasive surgical treatment include:

  • Damage to the surrounding structures ( heart, pericardium (sac around the heart) or nerves (Phrenic or recurrent laryngeal causing hoarseness

Imaging

  • Chest x-ray: not very specific, but leads to further testing
  • Computed tomography (CT): scan of the chest: the appearance of the mass suggests what the diagnosis is
  • Magnetic resonance imaging (MRI): of the chest: may help define the relationship of mediastinal masses to

Type Histologic Description

A     Tumor in which foci having features of type A thymoma are admixed with foci rich in lymphocytes.

B1   Tumor resembles normal functional thymus; combines large expanses having an appearance practically indistinguishable from that of normal thymic cortex with areas resembling thymic medulla.

B2  Tumor in which neoplastic epithelial component appears as scattered plump cells with vesicular nuclei and distinct nucleoli among a heavy population of lymphocytes; perivascular spaces are common and sometimes very prominent; a perivascular arrangement of tumor cells resulting in a palisading effect may be seen.

B3  Thymoma predominantly composed of epithelial cells having a round or polygonal shape and exhibiting no or mild atypia; they are admixed with a mild component of lymphocytes, resulting in a sheetlike growth of the neoplastic epithelial cells.

C   Thymic tumor exhibiting clear-cut cytologic atypia and a set of cytoarchitectural features no longer specific to the thymus, but rather analogous to those seen in carcinomas of the other organs; type C thymomas lack immature lymphocytes; whatever lymphocytes may be present are mature and usually admixed with plasma cells.