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Posterior mediastinal masses
N C Saenz1, J J Schnitzer, A E Eraklis
1Department of Surgery, Children's Hospital, Dana-Farber Cancer Institute, Boston, MA 02115.
Insights
Posterior mediastinal masses in children are often neurogenic tumors like neuroblastoma. Early diagnosis in the first year of life significantly improves survival rates for these pediatric masses.
Area of Science:
- Pediatric Oncology
- Thoracic Surgery
- Diagnostic Imaging
Background:
- Posterior mediastinal masses are common in children, frequently originating from neurogenic tumors.
- Neuroblastoma is the most prevalent type, accounting for a significant portion of these pediatric masses.
Purpose of the Study:
- To analyze the clinical presentation, origin, and outcomes of posterior mediastinal masses in pediatric patients.
- To evaluate the survival patterns and prognostic factors, particularly for neuroblastoma.
Main Methods:
- Retrospective review of 63 pediatric patients with posterior mediastinal masses diagnosed between 1972 and 1989.
- Analysis of tumor origin, presenting symptoms, diagnostic imaging (chest roentgenograms, CT, MRI), and patient follow-up data.
Main Results:
- 89% of masses were neurogenic, with neuroblastoma being the most common. 60% of all masses were malignant.
- 84% of patients were alive and disease-free at a median follow-up of 45 months.
- Patients with neuroblastoma diagnosed within the first year of life showed significantly better survival.
Conclusions:
- Posterior mediastinal masses in children are predominantly neurogenic, with neuroblastoma being a key diagnosis.
- Early detection and diagnosis, especially within the first year of life, are critical for improving outcomes in pediatric neuroblastoma.
- Comprehensive imaging, including CT or MRI, is essential for preoperative evaluation of these masses.
Abstract:
Solid mediastinal masses in infancy and childhood occur most frequently in the posterior mediastinum. From 1972 to 1989, 63 patients presented with a posterior mediastinal mass. The median age at diagnosis was 6 years (range, 1 day to 26 years). Thirty patients were female. Forty-five percent of the patients presented with respiratory symptoms or chest pain; 13% had neurologic symptoms, one half of which were related to spinal cord compression; and 5% had a palpable mass. In 32% of patients the mass was an incidental finding. The tumors were of neurogenic origin in 89% of patients, of which neuroblastoma was the most common. Of all patients with posterior mediastinal masses, 60% had malignant tumors. Median follow-up for 62 of 63 evaluable patients was 45 months (range, 1 to 289 months). One patient was lost to follow-up. Of the 62 patients followed, 84% are alive and free of disease. All but 4 of the 32 patients with neuroblastoma are alive and free of disease with a median follow-up of 73 months (range, 7 to 289 months). Patients with neuroblastoma who were diagnosed in the first year of life had a significantly better survival pattern than those presenting after the first year. There were seven deaths in the series: four from neuroblastoma, two from primitive neuroectodermal tumor, and one from malignant schwannoma. Preoperative diagnostic evaluation of a posterior mediastinal mass should include posteroanterior and lateral chest roentgenograms, and either CT or MRI of the chest and abdomen to assess the extent of the mass.(ABSTRACT TRUNCATED AT 250 WORDS)