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Week 4 MeadiastinumTumor - 20 November 2012
Week 4 MeadiastinumTumor - 20 November 2012
Week 4 MeadiastinumTumor - 20 November 2012
Yani Purnamasari
Sp.P
W ho is af e
fcted by m ediastinaltum ors?
In general, mediastinal tumors are rare. Mediastinal
Is a m ediastinal tum or
seri
Dueous?
to their location in the mediastinum
mediastinal tumors (both benign and
malignant) serious complications
including invading the heart, pericardium
(the lining around the heart), and great
vessels (the aorta and vena cava).
Tumors located in the posterior (back)
M iddle m ediastinum
Bronchogenic cyst A benign growth with respiratory origins.
Lymphadenopathy mediastinal An enlargement of the lymph
nodes.
Pericardial cyst A benign growth that results from an "out-pouching"
lymph nodes.
Neuroenteric cyst mediastinal A rare growth, which
H ow is a m ediastinaltum or diagnosed?
Chest x-ray
Computed tomography (CT) scan of the chest or CT-guided
needle biopsy
Magnetic resonance imaging (MRI) of the chest
Mediastinoscopy with biopsy (Performed under general
M ediastinaltum ors
Tumors of the mediastinum represent a wide diversity
of disease states
The most common causes of an anterior mediastinal
Thym om as
The most important determinants of
long term survival in thymoma are :
complete resection
Masaoka stage
WHO histologic classification
Strobel et al. Tumor recurrence and survival in
patients treated for thymomas and thymic Sq cell
carcinomas; A retrospective analysis. J Clin Oncol
2004 ;22;1501-1509
Thym om as
WHO classification of thymomas
WHO type Cytological Features
Type A Medullary, spindle cell
Type AB Mixed Thymomas
Type B1 Organoid, predominantly cortical , lymphocyte
predominant
Type B2 Cortical
Type B3 Well diff Ca , epithelial predominant , squamoid
Type C Thymic carcinoma
From Wilkins et al. Cases of Thymoma of the Massachusetts General Hospital .
J Thoracic Cardiovascular Surg 1966, 52; 322-330
Thym om as
Several studies have attempted to correlate morphologic
Thym om as
Influence of Masaoka stg on complete resection,
II
III
IVA
100
100
85
42
28
34
100
98
89
71
(ETT)
Stage II :ETT, radiation
Stage III : ETT & extended resection,
radiotherapy & chemotherapy
Stage IVA: Debulking,chemotherapy &
radiotherapy
Stage IVB: chemotherapy &
radiotherapy ,
debulking
carcinoma
Teratoma
Benigna
Malignant ( germinal cell, nongerminal,
immature)
Nonseminoma treatment :
Radioresisten & chemotherapy 6
cycle
Evaluation on 3-4 cycle with -HCG
& -fetoprotein, thoracs photo PA &
lateral
Malignan Teratoma :
Multimodality
(surgery,chemotherapy,radiotherapy
N eurogenic Tum or
Histologic classification :
Peripheral nerves
Neurofibroma
Neurilemoma (schwannoma)
Neurosarcoma
Symphathetic ganglia
Ganglioneroma
Ganglioneuroblastoma
Neuroblastoma
Paraganglionic
Pheochromacythoma
Paraganglioma
radiochemotherapy
Neurilemoma (Schwanoma)
chemotherapy adjuvant (prevent
reccurency)
Thank You
Endosko
pi
Foto
toraks
PA/lateral
Tomografi
CT Scan
toraks dg
kontras
Px. lain
Fluoroskop
i,Esofagog
rafi,Angiog
rafi, USG,
Kedoktera
n Nuklir,
MRI
Bronkosko
pi,
Mediastino
skopi,
Esofagosko
pi,
Torakoskop
i
Histopatolo
gi
Laboratori
um
Sitologi,B
JH/FNAB,
punksi
Pleura,
Bilasan/si
katan/BA
L
bronkus
Histologi:
Biopsi
KGB/Dani
el, Biopsi
Mediastin
al, Biopsi
Eksisiona
l
TTB, TTB
CTGuide
Torakosk
opi,
VATS,Bio
psi lain
Torakotom
i
eksplorasi
-Fetoprotein,
-HCG
Prosedur
tdk dpt
dilakukan
Radiasi
300-1000
cGy
Prosedur
diagnost
ik
lanjutka
Beda
h
Kegawatan
napas
Steroid + Radiasi 3001000 cGy + stand by
bedah
Respons
(+)
(klinis
membai
k)
Prosedur
diagnostik
dilanjutka
n
Respons
(-) (msh
ada
gangguan
)
Beda
h
ECC
(Extra
Corpored
Circulation
Tanpa
ECC
Gana
s
Limfom
a
Hodgkin
s
Penatalaksa
naan sesuai
dg Limfoma
Hodgkins
Non
Hodgkin
s
Penatalaksa
naan sesuai
dg Limfoma
Non
Hodgkins
Non
limfoma
Timom
a&
Tumor
Timus
Germ
cell
Tumo
r
neuro
genik
Tumor
mesengi
al &
Tumor
endokrin
Tidak perlu
terapi
lanjutan
Lanjutan
kemoterapi
Reseksi
bedah
Tumor dpt
diangkat /
ada sisa
tumor
Lanjutka
n
kemotera
pi
Kadar HCG
atau AFP
meningkat
Kadar
HCG &
AFP tetap
tinggi
Suportive
care
K lasifi
kasiTum or m ediastinum m enurut
R osen berg
Neurogenic
Endocrine
Tumor
Seminoma
Thyroid
Neurofibroma
Nonseminomatous
tumors
Thyroid
Neurilemoma
(Schwanoma)
Parathyroid
Neurosarcoma
Cysts
Arising from
symphatetic ganglia
With seminomatous
elements
Pericardial
Ganglioneuroma
With trophoblastic
elements
Bronchogenic
Ganglioneuroblastoma
Enteric
Neuroblastoma
Thymic
Arising from
paraganglionic tissue
Teratoma,benign
Thoracic duct
Pheochromocytoma
Meningoceles
Thymic
Aneurysms
Hernias
Thymoma
Mesenchymal Tumors
Hiatal
Carcinoid
Morgagni
Thymolipoma
Lymphoma
Rhabdomyosarcoma
Lymphadenopat
hy
Hodgkins disease
Xantogranuloma
Inflamatory
Histiocytic
Lymphoma
Mesenchymoma
Granulomatous
Undifferentiated
Hemangioma
Sarcoid
Hemangioendothelioma
Hemangiopericytoma
Lymphangioma
Lymphangiomyoma