eman_shalabi

Eman Muhammad Salah El-Deen Muhammad Shalabi

Professor - Professor Emeritus of Pathology

Faculty of medicine

Address: القوصية - محافظة أسيوط

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Diseases of the Mediastinum for Postgraduates of Pathology and Cardiothoracic Surgery

2018-09-29 16:36:09 |

DISEASES OF THE MEDIASTINUM

MEDISTINUM

Mediastinal boundaries

Mediastinal divisions: superior and inferior compartments

The latter is divided into anterior, middle and posterior compartments

 

Mediastinal Diseases

Classification Of Mediastinal Diseases

Non neoplastic lesions

Neoplastic lesions

 

Anterior mediastinal disorders

Thymic disorders

Thymoma, thymic carcinoma

Thymic carcinoid

Thymolipoma

Thymic cyst

Thymic hyperplasia

Thyroid disorders

Intrathoracic goiter

Germ cell tumors

Teratoma

Seminoma

Others

Lymphoma

Hodgkin’s disease

Non-Hodgkin’s

Parathyroid adenoma

Mesenchymal tumors

 

Middle mediastinal disorders

Lymphoma

Benign lympadenopathy

Granulomatous disease

Miscellaneous

Metastatic lymphadenopathy

Cysts

Bronchogenic cysts

Pericardial cyst

Vascular Lesions

Aneurysm

Hemangioma

Miscellaneous

Diaphragmatic hernias

Pancreatic pseudocyst

 

Posterior Mediastinal Disorders

Neurogenic tumors

Peripheral nerve

      Schwannoma, neurofibroma etc

Sympathetic ganglia

Ganglioneuroma, neuroblastoma ….etc.

Paraganglionic tumors

Pheochromocytoma

Esophageal disorders

Benign tumors

Esophageal diverticulum

Spinal

Lateral thoracic meningocele

Paraspinal abscess

Miscellaneous

Thoracic duct cysts

 

Inflammatory diseases

Acute mediastinitis

 ‘Danger space’

Chronic mediastinitis

Mycotic, Mycobacteria TB, Nocardia

Fibrosing mediastinitis

 

Congenital Cysts
Mediastinal Cysts (other than Thymic)

Pericardial (coelomic) cysts

Pericardial sac is formed by fusion of multiple disconnected lacunae.

Foregut cysts

Bronchial cysts

Esophageal cysts

Esophageal cysts

Gastric and Enteric cysts

 

The gastric type

The enteric type

Gastroenteric cysts

Pancreatic cysts and pseudocysts

Other Cysts

Thoracic duct cyst: cystic lymphangiomas

Adenomatoid tumor

Thyroid and parathyroid lesions

Thyroid tumors and tumor-like conditions

Parathyroid tumors and tumor-like conditions

Parathyroid cysts

 

Thymus

Anatomy of Thymus Gland

The cortex

The medulla

The cell

The thymus undergoes normal involution after puberty, although it never disappears completely

 

Thymic Cysts

Unilocular  thymic cysts

Multilocular thymic cyst

Dubois abscesses

Other Non-Neoplastic Diseases

Ectopic thymus

 Acute Thymic Involution

Acute thymic involution

Diffuse Thymic Fibrosis

True Thymic Hyperplasia

Thymic Follicular Hyperplasia

Thymic follicular hyperplasia

Myasthenia gravis

Langerhans Cell Histiocytosis

Microscopic appearance

 

TUMORS OF THE MEDIASTINUM 
THYMOMA AND THYMIC CARCINOMACARCINOMA

Classification of Thymic Tumors

Historically

The descriptive scheme

The scheme based on topographic and morphofunctional characteristics

Müller-Hermelink scheme comprises the following 5 types

The World Health Organization (WHO) Classification of Tumors of the Thymus and other thoracic tumors

 

Thymoma and Thymic Carcinoma

General Features

Thymoma

Location of thymoma

Radiographically

Fine-needle aspiration

Pathologic Features of Thymoma

Grossly

 “Microthymomas”

Microscopically

By electron microscopy

Immunohistochemistry

Classification of Thymoma

The subtypes of thymomas included in the WHO classification

Type A Thymoma (Spindle Cell; Medullary)

Type AB Thymoma (Mixed)

Type B1 Thymoma (Lymphocyte-Rich; Lymphocytic; Predominantly Cortical; Organoid)

Type B2 Thymoma (Cortical)

Type B3 Thymoma (Epithelial; Atypical; Squamoid; Well-Differentiated Thymic Carcinoma)

Rare subtypes of thymoma that do not easily fit into the A-B nomenclature include

Micronodular thymoma

Metaplastic thymoma

Microscopic thymoma (nodular hyperplasia)

Cytology

Limitations of the procedure

 

Thymic Carcinoma

Thymic tumor

Thymic Carcinoma

Differences from other conventional types of thymoma

Diagnosis

Squamous Cell Carcinoma (SCC)

Basaloid Carcinoma

Differential diagnosis

Mucoepidermoid Carcinoma

Lymphoepithelioma-Like Carcinoma

Clear cell carcinoma

Sarcomatoid Carcinoma (Carcinosarcoma)

 “Phenotypic switch”, myoid cells, “triton tumor”, metaplastic thymoma

“orthotopic” counterpart

Adenocarcinomas

NUT (midline) carcinoma

Undifferentiated (Anaplastic) Carcinoma

Rare variants of thymic carcinomas

Cervical Tumors of Thymic or Branchial Pouch Derivation

Ectopic (cervical) thymoma

Ectopic hamartomatous thymoma

Spindle epithelial tumor with thymus-like elements (SETTLE

Microscopically

Differential diagnosis: synovial sarcoma

Carcinoma with thymus-like elements (CASTLE)