Sharma Preeti, Jha Vidya, Kumar Naveen, Kumar Rohit, Mandal Ashish
1Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New DELHI, INDIA.
Turk Patoloji Derg. 2017;33(1):37-46. doi: 10.5146/tjpath.2016.01371.
The mediastinum is the central portion of the thoracic cavity, housing numerous organs and harbouring a mixed bag of non-neoplastic and neoplastic lesions. Accurate diagnosis is essential owing to the widely variable therapeutic and prognostic implications.
Cases of mediastinal masses were retrospectively reviewed from January 2011 till January 2016. Clinico-radiological records of these cases were retrieved. Fine needle aspiration cytology (FNAC) was performed wherever feasible. Histopathological and immunohistochemical evaluation of the excised specimens was undertaken.
Of the 60 cases included in our study, 22 were anterior, 20 were middle and 18 posterior mediastinal masses. The majority of the patients were symptomatic (96.8%). The most common pathology was thymoma (12 cases) followed by ten cases of lymphoma, eight cases each of tubercular lymphadenopathy and schwannoma, six cases of neurofibroma, four cases of extragonadal germ cell tumours, two cases each of thymic cyst, bronchogenic cyst, retrosternal goitre, ganglioneuroma and neuroblastoma, and one case each of lipoma and thymolipoma. FNAC was done in 54 cases of which 7 cases yielded inadequate material. Immunohistochemistry was required for classification of lymphoma cases and confirmation of a mixed component in germ cell tumours.
Mediastinal masses create significant diagnostic dilemma for the clinicians, radiologists and histopathologists. While imaging studies help in narrowing the differential diagnosis, accurate categorisation is not always possible. FNAC is a useful and cost effective tool. However, sampling error and complexities in performing the technique are major hurdles in the usefulness of this diagnostic modality.
纵隔是胸腔的中央部分，容纳众多器官，并存在各种非肿瘤性和肿瘤性病变。由于治疗和预后影响差异很大，准确诊断至关重要。
回顾性分析2011年1月至2016年1月间纵隔肿块病例。检索这些病例的临床放射学记录。在可行的情况下进行细针穿刺细胞学检查（FNAC）。对切除标本进行组织病理学和免疫组织化学评估。
在我们研究纳入的60例病例中，22例为前纵隔肿块，20例为中纵隔肿块，18例为后纵隔肿块。大多数患者有症状（96.8%）。最常见的病理类型是胸腺瘤（12例），其次是淋巴瘤10例、结核性淋巴结病和神经鞘瘤各8例、神经纤维瘤6例、性腺外生殖细胞肿瘤4例、胸腺囊肿、支气管源性囊肿、胸骨后甲状腺肿、神经节瘤和神经母细胞瘤各2例，脂肪瘤和胸腺脂肪瘤各1例。54例进行了FNAC，其中7例取材不足。淋巴瘤病例分类和生殖细胞肿瘤混合成分确认需要免疫组织化学检查。
纵隔肿块给临床医生、放射科医生和组织病理学家带来了重大诊断难题。虽然影像学检查有助于缩小鉴别诊断范围，但并不总是能够准确分类。FNAC是一种有用且经济有效的工具。然而，采样误差和技术操作的复杂性是这种诊断方法实用性的主要障碍。
