PRIMARY MEDIASTINAL MASSES IN INFANTS AND CHILDREN
Soheila Khalilzadeh, Nooshin Baghaie, Mohammad Reza Boloursaz, Maryam Hasanzad, AmirAli KhodayariDepartment of Pediatrics, Shaheed Beheshti University of Medical Sciences, IR IranAddress for Correpondence: Soheila Khalilzadeh, Masih Daneshvari Hospital, Darabad Ave, Tehran, IR Iran. E-mail: firstname.lastname@example.org Primary mediastinal malignancies are rare in children. 78% of patients are diagnosed as having solid tumors (1). Approximately one half of the masses are malignant, and of neurogenic or lymphomatous origin. According to different reports, neurogenic tumors predominate before the age of 4 years, while lymphomas are most common beyond age 4 and germ cell tumors are seen in adolescence. 66% of the malignancies are potentially curable by surgery, radiotherapy, and chemotherapy (2). The most common chest wall malignancies in children are sarcomas including Ewing's sarcoma of the bone or soft tissue and peripheral primitive neuroectodermal tumor (PPNET) (3). Compared to adults, children with mediastinal masses have more neurogenic tumors and with less frequency thymomas (4). In this study we evaluated the clinical manifestations, age range, and method of diagnosis and treatment of children with mediastinal masses presenting to the pediatric ward of Masih Daneshvari Hospital. This was a retrospective study performed in pediatric ward of Masih Daneshvari Hospital and evaluated the medical records of hospitalized children under 15 years of age with a mediastinal mass during 2001-2006. There were a total of 45 children, 27 males (60%) and 18 females (40%) with the mean age of 92 months (range 4 months to 15 yrs). Most cases were at the age range of 10 to 15 yrs (58%). Boys and girls comprised 61% and 39% of all malignant cases respectively. 82.2% of masses were malignant out of which 67.3% were nodular sclerosing Hodgkin's lymphoma followed by T-cell lymphoblastic lymphoma (17% of the masses). In one case, the diagnosis was cervical lymphangioma with invasion to the mediastinum. The most significant radiographic findings were mediastinal masses (44%) and hilar lymphadenopathy (31%). Regarding the site of involvement, anterior mediastinum, middle mediastinum and posterior mediastinum were involved in 84.4%, 11% and 4.6% of the cases respectively. 71% of children underwent chemotherapy, 16% underwent surgery for resection of the tumor and 13% were treated with both surgery and chemotherapy. Clinical features are depicted in Table 1.
Table 1: Clinical Features of Mediastinal masses
DyspneaCoughFeverWeight LossPleuritic Chest painDysphagiaMusculoskeletal painLymphadenopathySupraclavicularAxillaryAnemia or pancytopeniaHepatosplenomegalyLung MassSVC Syndrome
3%55%37%22%20%8%5%44%37%7%8%5%8%6% Conclusion: According to the results of this study, almost 82.2% of mediastinal masses in children were malignant and the majority of them were lymphomas or neurogenic tumors. Malignant lesions were mostly seen in boys older than 10 yrs; whereas, children younger than 5 yrs had benign tumors on pathological examination. Based on our study results, since lymphatic malignancies comprise a high percentage of pediatric mediastinal masses which respond well to chemotherapy, in those with suspicious chest x ray and significant hematologic disorders found on paraclinical tests, mediastinal masses should be seriously considered.
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Roy T, Nechol A, Theresa CH, Richard C. Primary mediastinal malignancies in children: Report of 22 patients and comparison to 197 Adults. Oncologist 2000.5:179-184. Latest Updated On: 1st March 2009 Vol 6 Issue 3 Art # 13 Advance Access: 1st March 2008
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Khalilzadeh S, Baghaie N, Boloursaz MR,Hasanzad M,Khodayari A. Primary Mediastinal Masses in Infants and Children . Pediatric Oncall [serial online] 2009 [cited 2009 March 1];6. Art # 13. Available from:
http://www.pediatriconcall.com/fordoctor/viewersChoice/mediastinal_masses.aspAdvance Access: 1st March 2008