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The Annals of Thoracic Surgery, Vol 51, 378-384, Copyright © 1991 by The Society of Thoracic Surgeons

ARTICLES

Primary cysts and tumors of the mediastinum

AJ Cohen, L Thompson, FH Edwards and RF Bellamy
Department of Thoracic Surgery, Walter Reed Army Medical Center, Washington, DC 20307-5001.

A retrospective analysis was performed on 230 patients with primary cysts and tumors of the mediastinum seen at our institution from January 1944 to April 1989. We divided these patients into two groups. Group 1 was seen before 1970 and group 2 was seen from January 1970 to April 1989. There was a significant increase in the prevalence of malignancy in group 2 (47.2% versus 17.1%; p less than 0.0001) due to an increase in the number of lymphomas (22.6% versus 3.5%; p less than 0.001) and malignant neurogenic tumors (6.8% versus 1.1%; p = 0.0528). There was a significant increase in the number of malignant tumors in the anterior (59.5% versus 30.9%; p = 0.0022) and paravertebral (28.5% versus 2.8%; p = 0.0027) compartments in group 2. More patients with these tumors were symptomatic in group 2 (63.6% versus 5%; p = 0.0422). There was an increase of ancillary diagnostic studies performed to evaluate these tumors (76.0% versus 34.5%; p = 0.0422). Logistic regression analysis identified date of presentation (p less than 0.005), symptoms (p less than 0.01), size (p less than 0.005), and the anterior mediastinal compartment (p less than 0.005) as preoperative predictors of malignancy. The surgical approach to these tumors included more median sternotomy (30.1% versus 10.7%; p = 0.0008), anterior mediastinotomy, and cervical mediastinoscopy in group 2 (1.1% versus 17.5%; p = 0.0002). Long-term results support surgical resection in benign lesions and an aggressive multimodality approach to malignant lesions.

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