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[Primary mediastinal tumors in children--comparison with mediastinal tumors in adults]
1First Department of Surgery, Osaka University Medical School, Osaka, Japan.
Insights
This study analyzed 628 mediastinal tumors in children and adults, finding adults have more malignant tumors. Children more frequently experienced dyspnea and required emergency operations for mediastinal tumors.
Area of Science:
- Thoracic Surgery
- Pediatric Oncology
- Surgical Pathology
Background:
- Mediastinal tumors represent a diverse group of neoplasms.
- Understanding age-specific differences in mediastinal tumor types and outcomes is crucial for effective treatment.
Purpose of the Study:
- To analyze the characteristics of primary mediastinal tumors in pediatric and adult populations.
- To compare the incidence of benign versus malignant tumors and specific tumor types between children and adults.
- To evaluate clinical manifestations and surgical management differences.
Main Methods:
- Retrospective review of 628 patients with primary mediastinal tumors undergoing surgical operation.
- Categorization of patients into pediatric (≤15 years) and adult groups.
- Analysis of tumor types, malignancy rates, clinical presentations, and surgical interventions.
Main Results:
- Adults (83.1%) predominated over children (16.9%) in the study cohort.
- Neurogenic tumors (44.3%) and teratomas (19.8%) were most common in children, while thymoma (36.2%) and teratoma (17.1%) were most frequent in adults.
- Adults had a significantly higher rate of malignant tumors (46.9%) compared to children (33.1%).
- Dyspnea was more prevalent in children (15.1%) than adults (11.3%), with children undergoing emergency operations more frequently.
Conclusions:
- Significant differences exist in the types and malignancy rates of mediastinal tumors between pediatric and adult patients.
- Children with mediastinal tumors present with distinct symptom profiles and require distinct surgical considerations, including a higher likelihood of emergency operations.
Abstract:
During the past 43 years, 628 patients with a primary mediastinal tumor underwent surgical operation in our institution. Of those patients, 106 patients (16.9%) were children of 15 yr of age or less and 522 patients (83.1%) were adults. 47 (44.3%) of the 106 children had neurogenic tumors, while 21 patients (19.8%) had a teratoma. 189 (36.2%) of the 522 adults had thymoma and 89 patients (17.1%) had teratoma. In the 106 children there were 71 benign tumor patients (66.9%) and 35 malignant tumor patients (33.1%). There were 277 (53.1%) benign and 245 (46.95) malignant tumors in the 522 adults. The adults had significantly more malignant tumors than the children (p < 0.01). In our series of malignant mediastinal tumors in children, 14 patients (13.3%) had a lymphoma and 11 patients (10.5%) had a neuroblastoma. On the other hand, in the adults, 127 patients (24.3%) had a thymoma and 66 patients (12.6%) had a lymphoma. Regarding benign mediastinal tumors, in children, 30 patients (28.5%) had a ganglioneuroma and 19 patients (18.0%) had a teratoma. In the adults, 68 patients (13.0%) had a teratoma and 62 patients (11.9%) had a thymoma. In the clinical manifestation, 51 child patients (48.1%) and 191 adult patients (36.6%) were asymptomatic. As symptoms due to compression or direct invasion to adjacent structures, dyspnea was seen in 16 child patients (15.1%), and chest pain occurred in 59 adult patients (11.3%). Dyspnea was significantly more common in children than in in adults (p < 0.01). Emergency operations were performed in children more than in adults.