Definition

Mediastinal tumors are growths that form in the mediastinum. This is an area in the middle of the chest that separates the lungs.

Alternative Names

Thymoma - mediastinal; Lymphoma - mediastinal

Causes

The mediastinum is the part of the chest that lies between the sternum and the spinal column, and between the lungs. This area contains the heart, large blood vessels, windpipe (trachea), thymus gland, esophagus, and connective tissues. The mediastinum is divided into three sections:

• Anterior (front)
• Middle
• Posterior (back)

Mediastinal tumors are rare.

The common location for tumors in the mediastinum depends on the age of the person. In children, tumors are more common in the posterior mediastinum. These tumors often begin in the nerves and are noncancerous (benign).

Most mediastinal tumors in adults occur in the anterior mediastinum. They are usually cancerous (malignant) lymphomas, germ cell tumors, or thymomas. These tumors are most common in middle aged and older adults.

Symptoms

Almost one half of mediastinal tumors cause no symptoms and are found on a chest x-ray done for another reason. Symptoms that do occur are due to pressure on (compression of) local structures and may include:

• Chest pain
• Fever and chills
• Cough
• Coughing up blood (hemoptysis)
• Hoarseness
• Night sweats
• Shortness of breath

Exams and Tests

A medical history and physical examination may show:

• Fever
• High-pitched breathing sound (stridor)
• Swollen or tender lymph nodes (lymphadenopathy)
• Unintentional weight loss
• Wheezing

Further tests that may be done include:

• Chest x-ray
• CT-guided needle biopsy
• CT scan of the chest
• Mediastinoscopy with biopsy
• MRI of the chest

Treatment

Treatment for mediastinal tumors depends on the type of tumor and symptoms:

• Thymic cancers are treated with surgery. It may be followed by radiation or chemotherapy, depending on the stage of the tumor and the success of the surgery.
• Germ cell tumors are usually treated with chemotherapy.
• For lymphomas, chemotherapy is the treatment of choice, and is possibly followed by radiation.
• For neurogenic tumors of the posterior mediastinum, surgery is the main treatment.

Outlook (Prognosis)

The outcome depends on the type of tumor. Different tumors respond differently to chemotherapy and radiation.

Possible Complications

Complications of mediastinal tumors include:

• Spinal cord compression
• Spread to nearby structures such as the heart, lining around the heart (pericardium), and great vessels (aorta and vena cava)

Radiation, surgery, and chemotherapy can all have serious complications.

When to Contact a Medical Professional

Contact your health care provider if you notice symptoms of a mediastinal tumor.

References

McCool FD. Diseases of the diaphragm, chest wall, pleura, and mediastinum. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 92.

Triplette M, Varghese TK, Cheng GS. Mediastinal tumors and cysts. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 115.