Alpaslan ÇAKAN, Gökhan YUNCU, Mehmet AŞKIN, Şencan AKDAĞ, Serpil SEVİNÇ, Güven OLGAÇ, Örs Şeyda KAYA, Hatice ALICI

Primer mediasten tümör ve kistli 53 olgunun retrospektif değerlendirilmesi

Amaç: Mediastinal kitlelerde hem tanıyı kesinleştirmek, hem de radikal tedaviyi sağlamak için seçilecek yöntem olan rezeksiyonun erken dönem sonuçlarının incelenmesi amaçlandı. Materyal ve Metod: 1984 - 1999 yılları arasında primer mediasten tümör ve kisti ön tanısıyla ameliyat edilen 53 olguyu kapsayan bu çalışmada hastalar yaş, cinsiyet, yakınma, klinik bulgu, preoperatif radyolojik işlem ve operatif yöntemler açısından retrospektif olarak incelendi. Yirmidokuzu erkek, 24'ü kadın 53 hastanın yaşları 6-69 arasında değişmekte olup ortalama 38.2 ± 12.26 yıl idi. En sık izlenen semptom göğüs ağrısı (%43) ve öksürük (%15) olup, olguların çoğunda (%58) fizik muayene normaldi. Tümör ve kistlerin çoğu ön mediastende (%43.4) lokalize iken, bunu orta (%28.3) ve arka (%28.3) mediasten yerleşimleri izlemekteydi. Bulgular: Tümör grubunda en sık nörojenik (%25) olanlar saptanırken, bunu sırasıyla timik tümörler (%19), teratom (%17) ve lenfoma (%9) izlemekteydi. Kist grubunda ise sadece bronkojenik (%17) ve perikardiyal (%7) kistler saptandı. Olguların çoğuna (%83) posterolateral torakotomi ile yaklaşılıp %92'sine total ve %4'üne parsiyel ekstirpasyon uygulanırken, olguların %4'ünde biyopsi ile yetinildi. Erken postoperatif dönemde malign timoma - myastenia gravisli bir olgu dışında operatif mortalite görülmedi. Sonuç: Operatif mortalitenin düşüklüğü, kesin tanının ekstirpasyonu izleyen histopatolojik incelemeyle konmasının güvenilirliği ve çoğu kez radikal tedaviyi sağlamadaki üstünlükleri nedeniyle cerrahi rezeksiyonun öncelikle seçilmesi gereken yöntem olduğu kanısına varıldı.

Retrospective evaluation of 53 cases with primary mediastinal tumors and cysts

Background: The aim of this study was to evaluate the early results of resection that should be the selected method for the certain diagnosis and radical treatment of mediastinal masses. Methods: In this retrospective study, we reviewed 53 cases with primary mediastinal tumor and cyst, who were treated surgically between 1984 and 1999, in respect to their age, gender, presenting symptoms, preoperative radiological investigations and surgical technique. There were 29 male and 24 female patients, and their age ranged from 6 to 69 with a mean of 38.2 ± 12.26 years. The most frequent presenting symptoms were chest pain (43%) and cough (15%). Physical examination was normal in majority of patients (58%). Most of the tumors and cysts (43.4%) located in the anterior mediastinum, while others were equally distributed (28.3%) in the middle and posterior mediastinum. Results: In the tumor group, the most frequent histopathological diagnosis was neurogenic tumors (25%) followed by thymic tumors (19%), teratomas (17%) and lymphomas (9%). Origin of the cysts was bronchogenic in 17%, pericardial in 7% of the patients. Majority of cases (83%) underwent posterolateral toracotomy and complete resection was possible in 49 patients (92%). Partial resection could only be performed in 4%. The biopsies of mediastinal masses were only performed in 4% of patients. Only one patient with malignant thymoma and myastenia gravis died in the early postoperative period. Conclusion: With low operative mortality rate and high potential for cure, since obtaining definitive diagnosis can often be achieved only on the basis of operative findings and histopathological examination of the gross specimen, surgical resection should be considered first in the management of primary mediastinal tumors and cysts.

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