Tani Kengo, Kimura Daisuke, Matsuo Tsubasa, Sasaki Takahiro, Kimura Shuta, Muto Chisaki, Minakawa Masahito
Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
Mediastinum. 2024 Feb 22;8:34. doi: 10.21037/med-23-40. eCollection 2024.
Giant anterior mediastinal tumors sometimes may cause circulatory collapse and respiratory failure, known as mediastinal mass syndrome (MMS). The prediction and prevention of MMS is challenging. The aim of this study is to summarize the evaluation methods for MMS and formulate treatment strategies for giant anterior mediastinal tumors.
We performed a thorough analysis of recent international literature on giant anterior mediastinal tumors (>10 cm in diameter) and MMS published in the PubMed database. The search spanned the duration of the preceding 10 years from August 19, 2023, and only studies published in English were included.
Mature teratomas and liposarcomas are the most common giant anterior mediastinal tumors and MMS develops most frequently in case of malignant lymphomas. Here, we propose a new treatment strategy for giant anterior mediastinal tumors. Based on imaging findings, giant anterior mediastinal tumors can be classified as cystic or solid and further blood investigation data are useful for a definitive diagnosis. When malignant lymphoma or malignant germ cell tumor is highly suspected, the first choice of treatment is not surgery but chemotherapy and radiotherapy. Moreover, image-guided drainage may be effective if giant cystic anterior tumors develop into MMS. The risk classification of MMS is important for treating giant anterior mediastinal tumors. If the MMS risk classification is 'unsafe' or 'uncertain', the intraoperative management deserves special attention. The surgical approach should however be based on tumor localization and invasion of surrounding tissues. Multidisciplinary team coordination is indispensable in the treatment of giant anterior mediastinal tumors.
When giant anterior mediastinal tumors are encountered, it is important to follow the appropriate treatment strategy, focusing on the development of MMS based on imaging findings and symptoms.
巨大前纵隔肿瘤有时可导致循环衰竭和呼吸衰竭，即纵隔肿块综合征（MMS）。MMS的预测和预防具有挑战性。本研究的目的是总结MMS的评估方法并制定巨大前纵隔肿瘤的治疗策略。
我们对PubMed数据库中最近发表的关于直径>10 cm的巨大前纵隔肿瘤和MMS的国际文献进行了全面分析。检索时间跨度为从2023年8月19日起的前10年，仅纳入以英文发表的研究。
成熟畸胎瘤和脂肪肉瘤是最常见的巨大前纵隔肿瘤，MMS最常发生于恶性淋巴瘤患者。在此，我们提出一种针对巨大前纵隔肿瘤的新治疗策略。根据影像学表现，巨大前纵隔肿瘤可分为囊性或实性，进一步的血液检查数据有助于明确诊断。当高度怀疑为恶性淋巴瘤或恶性生殖细胞肿瘤时，治疗的首选不是手术，而是化疗和放疗。此外，如果巨大囊性前纵隔肿瘤发展为MMS，影像引导下引流可能有效。MMS的风险分类对于治疗巨大前纵隔肿瘤很重要。如果MMS风险分类为“不安全”或“不确定”，术中管理值得特别关注。然而，手术方式应基于肿瘤的定位和对周围组织的侵犯情况。多学科团队协作在巨大前纵隔肿瘤的治疗中不可或缺。
遇到巨大前纵隔肿瘤时，遵循适当的治疗策略很重要，应根据影像学表现和症状关注MMS的发展情况。
