Related Experiment Videos
Pulmonary function is compromised in children with mediastinal lymphoma
D R King1, L E Patrick, M E Ginn-Pease
1Department of Surgery, Ohio State University College of Medicine, Columbus, USA.
Insights
Children with mediastinal lymphomas experience significant pulmonary function deficits. Non-Hodgkin
Area of Science:
- Pediatric Oncology
- Pulmonology
- Radiology
Background:
- Lymphomas are common childhood malignancies, often involving the mediastinum.
- Mediastinal tumors in children pose a risk of airway obstruction during anesthesia.
Purpose of the Study:
- To quantify airway obstruction and tracheal compression in pediatric Hodgkin's Disease (HD) and non-Hodgkin's lymphoma (NHL).
- To assess the functional significance of tracheal compression in children with mediastinal lymphomas.
Main Methods:
- Study included 51 children with HD and NHL.
- Pulmonary function tests (FVC, FEV1) and tracheal compression measurements were performed.
- Comparison between HD and NHL groups, symptomatic and asymptomatic patients, and large vs. small mediastinal masses.
Main Results:
- NHL patients had significantly worse pulmonary function (FVC 66% vs. 85% for HD).
- Respiratory symptoms were more common in NHL (76%) than HD (30%).
- Large mediastinal masses correlated with decreased pulmonary function and increased tracheal compression (44% vs. 27%).
Conclusions:
- Children with mediastinal lymphomas exhibit obstructive and restrictive pulmonary deficits.
- Pulmonary function is notably impaired in NHL patients, those with respiratory symptoms, and large mediastinal masses.
- Tracheal compression extent directly correlates with mediastinal mass size.
Purpose:
Lymphomas account for nearly 20% of the malignancies in childhood and the majority of patients with Hodgkin's Disease (HD) and non-Hodgkin's lymphoma (NHL) have radiological evidence of mediastinal involvement at presentation. Children with mediastinal tumors are at risk for the development of lethal airway obstruction during general anesthesia. This study quantitates the degree of the airway obstruction and the functional significance of tracheal compression in a cohort of 51 children with HD and NHL.
Results:
Thirty patients with HD (mean age, 14.6 years) and 21 with NHL (mean age, 9.2 years) were included in this study. Twenty-five children (49%) had respiratory symptoms at the time of presentation. Respiratory complaints were much more common in children with NHL (76%) when compared with those with HD (30%). Pulmonary function was also significantly worse in the NHL patients who had a mean upright forced vital capacity (FVC) of 66 +/- 21%. The comparable value for the children with HD was 85 +/- 15% (P = .031). Patients with respiratory symptoms at presentation had both obstructive and restrictive deficits of pulmonary function. Their mean upright forced expiratory volume in 1 second (FEV1) was 69 +/- 22% and the FVC was 69 +/- 18%. Children with large mediastinal masses also had significantly decreased pulmonary function compared with those with small tumors. The upright FEV1 for these two groups was 72 +/- 18% versus 98 +/- 15% (P = .016). Their FVC values were 68 +/- 20% and 91 +/- 17%, respectively (P = .049). Mean tracheal compression was measured at 44% in the children with large tumors versus 27% for those with small lesions (P = .048).
Conclusion:
Children with mediastinal lymphomas have both obstructive and restrictive deficits on pulmonary function testing. Pulmonary function is significantly decreased in patients with NHL, children who present with respiratory symptoms, and those with very large mediastinal masses (mediastinal mass ratio > 45%). The extent of tracheal compression correlates with the size of the mediastinal mass.