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Published on: February 12, 2017
Mediastinal tumors in children: a single institution experience
E Freud1, J Ben-Ari, T Schonfeld
1Department of Surgery, Schneider Children's Medical Center of Israel, Petah Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Insights
Pediatric mediastinal masses require multidisciplinary care, with most cases being malignant and necessitating prompt intervention. Early diagnosis and specialized treatment in a tertiary center are crucial for favorable outcomes.
Area of Science:
- Pediatric Oncology
- Thoracic Surgery
- Pediatric Intensive Care
Background:
- Mediastinal masses in children present diverse clinical challenges, ranging from asymptomatic findings to life-threatening emergencies.
- Compression of mediastinal structures can lead to rapid deterioration, including asphyxia.
Purpose of the Study:
- To review the characteristics, management, and outcomes of pediatric mediastinal masses.
- To highlight the importance of a multidisciplinary approach in managing these complex cases.
Main Methods:
- Retrospective review of 45 children with mediastinal masses admitted to a Pediatric Intensive Care Unit (PICU) between 1986 and 1999.
- Analysis of patient demographics, clinical presentation, diagnosis, treatment, and outcomes.
Main Results:
- 82.2% of masses were malignant, predominantly hematologic (40.5%) and neurogenic (27%) tumors.
- Emergency admissions (45% of cases) frequently presented with respiratory distress (19%), asphyxia (5), and superior vena cava syndrome (25%).
- Patients with benign masses were significantly younger; no intraoperative or postoperative deaths occurred.
Conclusions:
- Pediatric mediastinal masses are frequently malignant and require complex management.
- A multidisciplinary approach involving pediatric surgeons, anesthesiologists, intensivists, oncologists, and radiologists is essential.
- Treatment in a specialized tertiary center is recommended for optimal patient care and outcomes.
Abstract:
Mediastinal masses in children are a heterogeneous group of asymptomatic or potentially life-threatening congenital, infectious, or neoplastic lesions that present complex diagnostic and therapeutic dilemmas. Some patients are asymptomatic; in others, the mass may compress mediastinal structures and cause sudden asphyxia. In these cases, close cooperation is needed among pediatric surgeons, anesthesiologists, intensivists, oncologists, and radiologists. The files of 45 children with mediastinal masses admitted between 1986 and 1999 to the Pediatric Intensive Care Unit (PICU) of Schneider Children's Medical Center of Israel were reviewed. Twenty-one were admitted for perioperative care, and 21 for emergency care, including 19 with respiratory distress. Five of the emergency care group had asphyxia and 10 needed assisted ventilation. Two children were admitted for evaluation and 1 for leukopheresis. The children admitted on an emergency basis had more clinical findings than the postoperative group: almost 80% had dyspnea and more than 45% had oxygen desaturation; 33% had cough and noisy breathing, and 25%, superior vena cava syndrome or hepatosplenomegaly. Eight patients (17.8%) had benign disease and 37 (82.2%) malignant disease. The patients with a benign mass were significantly younger than the patients with a malignant mass (p<0.005); in 5 cases (12.5%), a congenital anomaly presented as a mediastinal mass. Most of the malignant masses were of hematologic origin (40.5%), followed by neurogenic tumors (27%). Twenty-seven patients underwent surgery, including 6 emergency procedures (3 partial resections, 2 biopsies, 1 lymph node biopsy). There were no intraoperative or postoperative deaths. The present series emphasizes the complex care children with a mediastinal mass require. They should be treated in a tertiary center with a multidisciplinary approach.
