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Mediastinal tumours and pseudo-tumours: a comprehensive review with emphasis on multidisciplinary approach

Maria-Rosa Ghigna, Vincent Thomas de Montpreville
European Respiratory Review 2021 30: 200309; DOI: 10.1183/16000617.0309-2020
Maria-Rosa Ghigna
Dept of Pathology, Marie Lannelongue Hospital, Le Plessis Robinson, France
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  • ORCID record for Maria-Rosa Ghigna
Vincent Thomas de Montpreville
Dept of Pathology, Marie Lannelongue Hospital, Le Plessis Robinson, France
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  • ORCID record for Vincent Thomas de Montpreville
  • For correspondence: v.thomasdemontpreville@hml.fr
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  • FIGURE 1
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    FIGURE 1

    Radiological and pathological appearance of a SMARCA4-deficient tumour. a) Initial chest radiograph and computed tomographic (CT) scan showing a mediastino-pulmonary tumour (*) with positivity on positron emission tomography; b) histology of the initial biopsy at medium magnification showing an undifferentiated tumour infiltrating fat, with mitoses and necrosis (*; top right); c) post-chemotherapy chest radiograph and CT scan showing tumour regression and macroscopic appearance of the surgical specimen showing a necrotic tumour infiltrating the left pulmonary upper lobe lung and pericardium (*).

  • FIGURE 2
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    FIGURE 2

    Radiological and pathological typical features of a multilocular thymic cyst. a) Computed tomographic (CT) scan showing the lesion in the anterior mediastinum; b) positron emission tomography showing a moderate hypermetabolism (standardised uptake value 3.7); c) gross appearance of the multilocular cystic lesion; d) histological appearance at low magnification showing several cavities with thick fibroinflammatory walls.

  • FIGURE 3
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    FIGURE 3

    Radiological and histological typical features of Müllerian cysts of the mediastinum. a, b) Magnetic resonance imaging showing a paravertebral cystic lesion; c) histological features at low magnification showing a cystic lesion resembling a fallopian tube; d) histological appearance of the ciliated epithelium of the cyst at high magnification; e) immunohistochemistry showing strong oestrogen receptor nuclear expression.

Tables

  • Figures
  • TABLE 1

    Frequencies of sex and age of 942 consecutive primary tumours and cysts of the mediastinum encountered in a 10-year period (2010–2019) at Marie Lannelongue Hospital (Le Plessis Robinson, France)

    CasesSexAge yearsTotal
    FMRangeMean
    Thymic lesions507 (53.8)
     Congenital cyst44 (8.55)202427–8164.10
     Multilocular cyst7 (1.39)4331–6229.61
     Cholesteroloma3 (0.59)0325–5335.07
     Myasthenia gravis138 (27.4)92468–6931.19
     Hyperplasia without myasthenia gravis36 (7.16)20168–7935.82
     Thymolipoma2 (0.4)1120–6140.86
     Thymomas239 (47.5)1211119–9058.43
     Thymic carcinomas27 (5.37)121514–8252.46
     Carcinoid tumours11 (2.19)2928–7253.33
    Nonthymic cysts61 (6.5)
     Bronchogenic20 (32.8)1287–6441.42
     Pleuro-pericardial38 (62.3)19199–7452.25
     Müllerian3 (9.84)3047–5752.09
    Lymphomas10411014–8441.20214 (22.7)
     Diffuse large B-cell81 (37.9)423915–8444.49
     Hodgkin lymphoma110 (51.4)555514–7736.72
     T-lymphoblastic10 (4.67)2818–6345.60
     Miscellaneous13 (6.07)5825–8358.06
    Germinal cell tumours16550–7430.7371 (7.5)
     Teratoma25 (35.2)14110–7428.16
     Malignant nonseminomatous37 (52.1)23515–6531.96
     Seminoma9 (12.7)0920–4832.80
    Benign connective tumours63 (6.7)
     Castleman disease4 (6.35)2230–7745.65
     Lipoma4 (6.35)2255–6159.50
     Angioma10 (15.9)370–7447.89
     Schwannoma25 (39.7)16910–7846.72
     Neurofibroma5 (7.94)2342–5644.37
     Ganglioneuroma6 (9.52)426–6030.03
     Paraganglioma9 (14.3)6315–7853.25
    Miscellaneous malignancies26 (2.8)
     Sarcomas21 (80.8)1296–7943.03
     Undifferentiated malignant tumours5 (19.2)3218–4841.30
    942 (100)

    Data are presented as n (%) or n, unless otherwise stated. F: female; M: male. Bold type represents significant features.

    • TABLE 2

      Frequency of myasthenia gravis and Masaoka–Koga stages according to histological types of thymomas in a series of 239 cases encountered in a 10-year period (2010–2019) at Marie Lannelongue Hospital (Le Plessis Robinson, France)

      CasesMyasthenia gravisMasaoka–Koga
      I/IIIII/IV
      A24 (10)1 (4.2)18 (75)6 (25)
      AB62 (25.9)7 (11)52 (83.9)10 (16.1)
      Micronodular5 (2.09)0 (0)4 (80)1 (20)
      B136 (15.1)15 (42)20 (58.8)14 (41.2)
      B269 (28.9)37 (54)40 (59.7)27 (40.3)
      B340 (16.7)22 (55)10 (25.6)29 (74.4)
      Unclassified3 (1.26)1 (33)1 (100)0 (0)
      Total239 (100)83 (35)145 (62.5)87 (37.5)

      Data are presented as n (%). Bold type represents significant features.

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      Mediastinal tumours and pseudo-tumours: a comprehensive review with emphasis on multidisciplinary approach
      Maria-Rosa Ghigna, Vincent Thomas de Montpreville
      European Respiratory Review Dec 2021, 30 (162) 200309; DOI: 10.1183/16000617.0309-2020

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      Mediastinal tumours and pseudo-tumours: a comprehensive review with emphasis on multidisciplinary approach
      Maria-Rosa Ghigna, Vincent Thomas de Montpreville
      European Respiratory Review Dec 2021, 30 (162) 200309; DOI: 10.1183/16000617.0309-2020
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      • Article
        • Abstract
        • Abstract
        • Introduction
        • Special considerations on biopsy sampling and histological analysis of mediastinal lesions
        • Anterior mediastinum (pre-vascular compartment)
        • Middle mediastinum
        • Posterior mediastinum
        • Conclusion
        • Footnotes
        • References
      • Figures & Data
      • Info & Metrics
      • PDF

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