MEDICAL RADIOLOGY. Diagnostic Imaging and Radiation Oncology

Transcription

1 MEDICAL RADIOLOGY Diagnostic Imaging and Radiation Oncology Editorial Board Founding Editors: L.W. Brady, M.W. Donner (t), H.-P. Heilmann, F.H.W. Heuck Current Editors: A.L. Baert, Leuven. L.W. Brady, Philadelphia H.-P. Heilmann, Hamburg. F.H.W. Heuck, Stuttgart. J.E. Youker, Milwaukee

2 Mediastinal Tumors Update 1995 Contributors M.S. Allen. ID. Bitran. L. Delbridge. B. De Vries. L.P. Faber R.I Ginsberg. T.W. Griffin. R.F. Heitmiller. S. Keshavjee W.-J. Koh. J. LeBlanc. R.B. Lee. PJ. Loehrer, Sr. WJ. Marasco. D.J. Mathisen J.I. Miller, Jr.. S.H. Petersdorf T.S. Reeve. M. Roach III. J. Somers. C.R. Thomas, Jr. S. Vijayakumar. IC. Wain. E.W. Wilkins, Jr.. D.E. Wood C.D. Wright Edited by Douglas E. Wood and Charles R. Thomas, Jr. Foreword by Luther W. Brady and Hans-Peter Heilmann With 55 Figures and 21 Tables Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Hong Kong Barcelona Budapest

3 DOUGLAS E. WOOD, MD Head, Section of General Thoracic Surgery Division of Cardio-thoracic Surgery Department of Surgery, SA-25 University of Washington 1959 NE Pacific Street Seattle, W A USA CHARLES R. THOMAS, JR., MD Fellow, Department of Radiation Oncology, RC-08 Former Assistant Professor, Division of Oncology Department of Medicine University of Washington 1959 NE Pacific Street Seattle, W A USA. MEDICAL RADIOLOGY. Diagnostic Imaging and Radiation Oncology Continuation of Handbuch der medizinischen Radiologie Encyclopedia of Medical Radiology ISBN-13 : e-isbn-13 : DOl: / CIP data applied for This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. Springer-Verlag Berlin Heidelberg 1995 Softcover reprint of the hardcover I st edition 1995 The use of general descriptive names, registered names, trademark, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Typesetting: Macmillan India Ltd., Bangalore 25 SPIN: /3130/SPS Printed on acid-free paper

4 Foreword Primary mediastinal tumors are relatively rare. The relative incidence of these tumors indicates that neurogenic tumors are the most common tumor seen constituting 21 % of all cases, thymomas 19%, lymphomas 12.5%, germ cell tumors 10%, primary carcinomas 4.6%, mesenchymal tumors 6%, endocrine tumors 6%, cysts 18%. In adults, the majority of thyroid tumors, thymomas, mediastinal germ cell tumors and teratomas are located in the superior and anterior mediastinum. Of the neurogenic tumors 18% are located in the posterior mediastinum, and 50% of mediastinal lymphomas are in the middle mediastinum. In adults, the incidence of anterosuperior, middle and posterior mediastinal tumors is about 54%, 20% and 26% respectively. However, in children the posterior mediastinum contains 63% of the lesions, the anterior mediastinum contains 26% and the middle mediastinum II %. The majority of the tumors are benign in character with a ratio of benign to malignant of about 60 to 40. The relative incidence of malignant mediastinal tumors in children is about 50%. Even though mediastinal tumors are not common, they represent a unique problem with regards to treatment whether by surgery, radiation therapy and/or systemically administered chemotherapy. The volume by WOOD and THOMAS deals with each of these issues in detail and presents a logical and important approach to the management of mediastinal tumors. Philadelphia Hamburg January 1995 LUTHER W. BRADY HANS-PETER HEILMANN

5 Preface Mediastinal tumors present a fascinating and varied array of benign and malignant neoplasms. Cardiothoracic surgeons, general surgeons, medical and radiation oncologists, radiologists, pulmonologists, pediatricians, endocrinologists, and pathologists are all involved in the diagnosis and management of mediastinal tumors. Due to this wide spectrum of diseases and specialists, the literature on mediastinal tumors is scattered through the journals of multiple disciplines. As a result, many physicians do not have a clear understanding of this diverse array of tumors. In the past few years diagnostic techniques have improved with serum tumor markers. MR!, and more sophisticated imaging by CT and ultrasound. At the same time, advances in chemotherapy, radiation, and surgery have improved the outcomes for tumors that were previously "incurable" and interdisciplinary cooperation has resulted in many multimodality treatment protocols. This volume is aimed at consolidating the literature and providing a concise guide and reference to the stateof-the-art diagnosis and management of mediastinal tumors. We have enlisted thoracic surgeons, medical and radiation oncologists, and radiologists who are experienced in specific mediastinal tumors to provide thorough updates in their area of expertise. We greatly appreciate their important contributions to the field and to this supplement. Seattle, W A 98195, USA February 1995 DOUGLAS E. WOOD CHARLES R. THOMAS, Jr. Acknowledgement. We wish to give our sincere thanks to TERRI BODEN MAN for all her help and hard work in preparing this volume. Without her dedication and perseverance this issue would probably be titled Mediastinal Tumors: Update 1997.

6 Contents Diagnosis of Mediastinal Masses JOHANNE LEBLANC and DOUGLAS E. WOOD 2 Thymoma: Surgical Management EARLE W. WILKINS, JR Thymoma: Radiation and Chemotherapy WUI-JIN KOH, PATRICK J. LOEHRER, SR., and CHARLES R. THOMAS, JR Mediastinal Lymphomas STEPHEN H. PETERSDORF 27 5 Benign Mediastinal Germ Cell Tumors MARK S. ALLEN Nonseminomatous Germ Cell Tumors of the Mediastinum CAMERON D. WRIGHT, JOHN C. WAIN and DOUGLAS J. MATHISEN 7 Primary Mediastinal Seminoma RICHARD F. HEITMILLER and WILLIAM J. MARASCO 8 Endocrine Tumors of the Mediastinum THOMAS S. REEVE and LEIGH DELBRIDGE 9 Mediastinal Paragangliomas ROBERT B. LEE and JOSEPH I. MILLER, JR Neurogenic Tumors of the Mediastinum JOHN C. WAIN Cardiac Neoplasms CHARLES R. THOMAS, JR., BRENT DE VRIES, JACOB D. BITRAN and THOMAS W. GRIFFIN Tracheal Tumors DOUGLAS E. WOOD 13 Mesenchymal Tumors of the Mediastinum JONATHAN SOMERS and L. PENFIELD FABER 14 Undifferentiated Carcinoma of the Mediastinum SHAFIQUE KESHAVJEE and ROBERT J. GINSBERG

7 X Contents 15 The Role of Tbree-Dimensional Conformal Radiotherapy in the Treatment of Mediastinal Tumors MACK ROACH III and SRINIVASAN VIJA Y AKUMAR Subject Index List of Contributors