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Primary mediastinal masses. A comparison of adult and pediatric populations
K S Azarow1, R H Pearl, R Zurcher
1Department of Thoracic Surgery, Walter Reed Army Medical Center, Washington, D.C. 20307-5001.
Insights
Pediatric and adult mediastinal tumors show distinct differences in type and malignancy rates. Understanding these variations is crucial for effective treatment planning in children with mediastinal masses.
Area of Science:
- Thoracic Surgery
- Pediatric Oncology
- Surgical Pathology
Background:
- Mediastinal tumors are rare in both pediatric and adult populations.
- Histologic types and clinical presentations can differ significantly between age groups.
Purpose of the Study:
- To compare pediatric and adult patients undergoing surgery for primary mediastinal cysts and tumors.
- To identify differences in tumor types, symptoms, and outcomes between pediatric and adult populations.
Main Methods:
- Retrospective review of 62 pediatric and 195 adult patients operated on for mediastinal masses since 1944.
- Comparison of histologic type, location, symptoms, physical findings, and surgical complications.
Main Results:
- Adults showed a higher prevalence of lymphoma (41/195) and children of neurogenic tumors (21/62).
- Malignancy rates increased since 1970 in both groups, linked to malignant neurogenic tumors in children and lymphomas in adults.
- Tumor characteristics predicted malignancy in adults but not in children; no difference in mortality/morbidity was observed.
Conclusions:
- Significant differences exist in the epidemiology and characteristics of mediastinal tumors between pediatric and adult patients.
- These age-related distinctions necessitate tailored evaluation and treatment strategies for pediatric mediastinal masses.
Abstract:
Since 1944 62 pediatric patients with primary cysts and tumors of the mediastinum have been operated on at our institution. We compared this group with 195 adult patients with similar diagnoses who were operated on during this period. Comparisons were made with regard to histologic type, location, presenting symptoms, physical findings, and surgical complications. We found significant increases in the prevalence of lymphoma in adults (41/195 versus 4/62, p < 0.05) and of neurogenic tumors in children (21/62 versus 24/195, p < 0.05). There were no significant differences in the prevalence of thymic tumors (51/195 versus 22/62), germ cell tumors (24/195 versus 4/62), and cysts (32/195 versus 15/62). There was no difference in the prevalence of symptomatic patients (99/195 versus 36/62). The prevalence of malignancy has increased in both groups since 1970 (2/28 versus 16/34 in children, p < 0.01; and 14/56 versus 69/139 in adults, p < 0.05). This is attributed to a rise in the prevalence of malignant neurogenic tumors in children and to an increase in the prevalence of lymphomas in adults. Tumor size, location, and the presence of symptoms were predictive of malignancy in the adult population but not in the pediatric population. No difference existed in mortality and morbidity between the two groups. All three pediatric deaths were directly related to loss of airway control as a result of mass effect from the tumor. Definite differences exist between the adult and pediatric populations with regard to mediastinal tumors. These differences need to be considered carefully when evaluating and planning treatment for a child with a mediastinal mass.