- Symptoms of Tumours of a mediastinum
- Reasons of Tumours of a mediastinum
- Treatment of Tumours of a mediastinum
Mediastinum new growths (tumors and cysts) in structure of all oncological diseases make 3-7%. Most often new growths of a mediastinum come to light at persons of 20-40 years, i.e. at the most active part of the population in the social plan. About 80% of the revealed new growths of a mediastinum belong to high-quality, and 20% - to malignant.
Mediastinum is called the part of a chest cavity limited in front - a breast, partially costal cartilages and a pozadigrudinny fascia, behind - a front surface of chest department of a backbone, necks of edges and a prevertebral fascia, from sides - leaves of a mediastinal pleura. From below the mediastinum is limited to a diaphragm, and from above - the conditional horizontal plane which is carried out through the upper edge of the handle of a breast.
The scheme of division of a mediastinum offered in 1938 by Tvayning - two horizontal (above and below roots of lungs) and two vertical planes is most convenient (in front of and behind roots of lungs). In a mediastinum, thus, it is possible to allocate three departments (front, average and back) and three floors (upper, average and lower).
The front department of an upper mediastinum is: a thymus, an upper part of an upper vena cava, brachiocephalic veins, an aortic arch and the branches departing from it, a brachiocephalic trunk, the left general carotid artery, the left subclavial artery.
The back department of an upper mediastinum is located: gullet, chest lymphatic channel, trunks of sympathetic nerves, vagus nerves, neuroplexes of bodies and vessels of a chest cavity, fascia and kletchatochny spaces.
In a front mediastinum are located: cellulose, spurs of an intrathoracic fascia in which leaves internal chest vessels, retrosternal lymph nodes, front mediastinal nodes are concluded.
On average department of a mediastinum are: a pericardium with the heart concluded in it and intra pericardiac departments of large vessels, bifurcation of a trachea and primary bronchi, pulmonary arteries and veins, phrenic nerves with the diafragmalnoperikardialny vessels accompanying them, fastsialnokletchatochny educations, lymph nodes.
The back department of a mediastinum is located: the descending aorta, unpaired and semi-unpaired veins, trunks of sympathetic nerves, vagus nerves, a gullet, a chest lymphatic channel, lymph nodes, the cellulose with spurs of an intrathoracic fascia surrounding bodies of a mediastinum.
According to departments and floors of a mediastinum it is possible to note certain preferential localizations of the most part of its new growths. So, it is noticed, for example, that the intrathoracic craw is located in the upper floor of a mediastinum, especially in its front department more often. Thymomas are found, as a rule, on average a front mediastinum, pericardiac cysts and lipomas - in lower front. The upper floor of average department of a mediastinum is the most frequent localization of teratodermoid. On average the floor of average department of a mediastinum bronchogenic cysts while gastroenterogenny cysts come to light in the first floor of average and back departments most often are found. The most frequent new growths of back department of a mediastinum on all its extent are neurogenic tumors.
Symptoms of Tumours of a mediastinum:
New growths of a mediastinum are found preferential at young and middle age (20 - 40 years), is equally frequent both at men, and at women. During a disease at new growths of a mediastinum it is possible to allocate the asymptomatic period and the period of the expressed clinical manifestations. Duration of the asymptomatic period depends on localization and the sizes of a new growth, its character (malignant, high-quality), growth rates, relationship with bodies and formations of a mediastinum. Very often mediastinum new growths a long time proceed asymptomatically, and accidentally find them at preventive X-ray inspection of a thorax.
Clinical signs of new growths of a mediastinum consist from:
- symptoms of a prelum or germination of a tumor in the next bodies and fabrics;
- general displays of a disease;
- specific symptoms characteristic of various new growths;
The most frequent symptoms are the pains arising owing to a prelum or germination of a tumor in nervous trunks or neuroplexes that is possible both at high-quality, and at malignant new growths of a mediastinum. Pains, as a rule, not intensive, localized on the party defeats, and quite often irradiate in a shoulder, a neck, interscapular area. Pains with left-side localization are often similar to pains at stenocardia. At emergence of ostealgias it is necessary to assume existence of metastasises. The prelum or germination by a tumor of a boundary sympathetic trunk causes emergence of the syndrome which is characterized by a blepharoptosis, a mydriasis and retraction of an eyeglobe on the party of defeat, sweating disturbance, change of local temperature and a dermographism. Damage of a recurrent guttural nerve is shown by an osiplost of a voice, a phrenic nerve - high standing of a dome of a diaphragm. The prelum of a spinal cord leads to disorders of function of a spinal cord.
Manifestation of a compression syndrome is also the prelum of large venous trunks and, first of all, an upper vena cava (a syndrome of an upper vena cava). It is shown by disturbance of outflow of a venous blood from the head and an upper half of a trunk: patients have a noise and weight in the head amplifying in inclined situation, a stethalgia, an asthma, puffiness and cyanosis of the person, an upper half of a trunk, swelling of veins of a neck and thorax. The central venous pressure increases to 300-400 mm w.g. At a prelum of a trachea and large bronchial tubes there is cough and short wind. The prelum of a gullet can cause a dysphagy - disturbance of passing of food.
At late stages of development of new growths arise: general weakness, fervescence, perspiration. weight loss which are characteristic of malignant tumors. At some patients manifestations of the disturbances connected with organism intoxication the products allocated by the growing tumors are observed. The artralgichesky syndrome reminding rhematoid polyarthritis concerns to them; pains and swelling of joints. hypostases of soft tissues of extremities, increase of heart rate, disturbance of a cordial rhythm.
Specific symptoms are inherent in some tumors of a mediastinum. So, the skin itch, night perspiration are characteristic of malignant lymphoma (a lymphogranulomatosis, a lymphoreticulosarcoma). Spontaneous decrease in level of sugar develops in blood at mediastinum fibrosarcomas. Symptoms of a thyrotoxicosis are characteristic, of an intrathoracic thyrocardiac craw.
Thus, clinical signs of new growths, mediastinums are very diverse, however they are shown in late stages of development of a disease and not always allow to establish the exact etiological and topografoanatomichesky diagnosis. Are important for diagnosis given radiological and tool methods, especially for recognition of early stages of a disease.
Reasons of Tumours of a mediastinum:
New growths of a mediastinum come from diverse fabrics and combine only one anatomic borders. Not only true tumors, but also various on localization, an origin and the course of a cyst and tumorous educations concern to them. All new growths of a mediastinum on a source of their origin can be divided into the following groups:
1. Primary new growths of a mediastinum.
2. Secondary malignant tumors of a mediastinum (metastasises of malignant tumors of the bodies located out of a mediastinum in lymph nodes of a mediastinum).
3. Tumors of bodies of a mediastinum (gullet, trachea, pericardium, chest lymphatic channel).
4. Tumors from the fabrics limiting a mediastinum (pleurae, breasts, diaphragms).
5. Pseudo-tumoral diseases (damage of lymph nodes at tuberculosis, a disease of Benye-Beka-Shaumyana, parasitic cysts, aneurisms and malformations of large vessels, limited inflammatory processes and some other).
The tumors and cysts which developed from fabrics, an embriogeneticheska inherent in mediastinal space or from the aberrant fabrics displaced in a mediastinum at disturbance of an embryogenesis belong to primary new growths of a mediastinum. The concept of primary new growths of a mediastinum includes tens various (by origin, to a histogenesis, the nature of growth) the tumors and cysts which are localized in various departments of a mediastinum. In clinic of thoracic surgery the following classification of primary new growths of a mediastinum is used.
Treatment of Tumours of a mediastinum:
Treatment of new growths of a mediastinum - operational. Removal of tumors and cysts of a mediastinum needs to be made as soon as possible as it is prevention of their malignancy or development of a compression syndrome. Only small lipomas and coelomic cysts of a pericardium in the absence of clinical manifestations and a tendency to their increase can be an exception. Treatment of malignant tumors of a mediastinum in each case demands individual approach. Usually an operative measure is the cornerstone of it.
Use beam and chemotherapy is shown at the majority of malignant tumors of a mediastinum, but in each case their character and contents are defined by biological and morphological features of tumoral process, its prevalence. Beam and chemotherapy are applied as in a combination with operational treatment, and independently. As a rule, conservative methods make a therapy basis at far come stages of tumoral process when performance of radical operation is impossible, and also at mediastinum lymphoma. Surgical treatment at these tumors can be justified only at early stages of a disease when process locally affects a certain group of lymph nodes that in practice meets not so often. In recent years it is offered and the videotorakoskopiya technique is successfully used. This method allows not only to visualize and document mediastinum new growths, but also to remove them by means of torakoskopichesky tools, putting the minimum operational injury to patients. The received results testify to high performance of this method of treatment and a possibility of carrying out intervention even at patients with serious associated diseases and low functional reserves.