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Malignant mediastinal mass in children: a single institutional experience from a developing country
Insights
This study on paediatric mediastinal masses found malignancy in 86% of cases, primarily lymphoma and leukaemia. While outcomes improved, a multidisciplinary approach is vital for better patient morbidity and mortality.
Area of Science:
- Pediatric Oncology
- Thoracic Surgery
- Diagnostic Imaging
Background:
- Mediastinal masses in children present a diagnostic challenge.
- Early identification and management are crucial for improving outcomes.
Purpose of the Study:
- To determine the clinical spectrum and management outcomes of pediatric mediastinal masses.
- To analyze presentation, diagnosis, and treatment effectiveness.
Main Methods:
- Retrospective review of 37 pediatric mediastinal mass cases (2005-2011).
- Evaluation of clinical presentation, histopathology, and radiologic findings.
- Analysis of management strategies and patient outcomes.
Main Results:
- Malignancy was diagnosed in 86% of cases, with lymphoma (72%) and leukemia (25%) being most common.
- Fever, cough, and dyspnea were the most frequent presenting symptoms.
- No deaths occurred due to the mass or diagnostic procedures, indicating improved management.
Conclusions:
- Despite reduced mortality, a high index of suspicion for pediatric mediastinal masses is essential.
- A comprehensive, multidisciplinary approach is critical for optimizing patient care and reducing morbidity.
Objective:
To determine the clinical spectrum and management outcomes of paediatric patients with modiastinal mass in a Karachi hospital.
Methods:
Medical records of all cases of mediastinal masses in children diagnosed and treated between January 2005 and December 2011 were retrospectively reviewed to evaluate the mode of presentation, histopathological diagnosis, radiologic findings and management outcomes at Aga Khan University Hospital, Karachi, Pakistan. SPSS 19 was used for data analysis.
Results:
A total of 37 patients of mediastinal masses were identified, and malignancy was found in 32 (86%) cases. The median age at diagnosis was 9 years (interquartile range: 4.7 years). Lymphoma 23 (72%) and leukaemia 8 (25%) were the most common causes of mediastinal mass. Nonspecific symptoms such as fever 26 (81%), cough 15 (47%) and dyspnoea 12 (37%) constituted the most commonly presenting complaints. Overall, 22 (68.7%) patients underwent surgical procedures (complete/partial resection of mass); local lymph node biopsy was performed in 5 (15.6%) cases; and computed tomography or ultrasound-guided biopsy was done in 2 (5.4%) patients. Besides, 27 (84.4%) patients were admitted to paediatric intensive care unit for supportive care, and assisted ventilation was required in 20 (62.5%) patients. The mean length of hospital stay was 9.3 +/- 6 days. None of the patients died due to complications related to mediastinal mass or diagnostic procedure.
Conclusions:
Although mortality rate has reduced significantly with refinements in the management protocols, but a high index of suspicion and comprehensive multidisciplinary approach is crucial to improve the morbidity and mortality.
