What is the pathophysiology of tumors of the mediastinum?

Updated: Feb 16, 2021
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Because of the malleable nature and small size of the pediatric airway and other normal mediastinal structures, benign tumors and cysts can produce abnormal local effects. These effects are usually more evident in children than in adults.

Compression or obstruction of portions of the airway, esophagus, or right heart and great veins by an enlarging tumor or cyst can easily occur and can result in a number of symptoms. Infection can occur primarily within some of these mediastinal lesions, particularly those of a cystic nature, or can result secondarily in nearby structures (eg, lungs) as a result of local compression or obstruction.

Because of the close proximity to the trachea and the limited space of the thoracic inlet, patients with intrathoracic extension of a cervical goiter commonly present with symptoms of upper airway compression and can also present with esophageal compression.

Malignant mediastinal tumors can cause all of the same local effects as those associated with benign lesions but, in addition, can produce abnormalities by invasion of local structures. Structures most commonly subject to invasion by malignant tumors include the tracheobronchial tree and lungs, esophagus, SVC, pleura and chest wall, and any adjacent intrathoracic nerves.

Pathophysiologic changes that can be produced by invasion of specific structures are obstructive pneumonia and hemoptysis; dysphagia; SVC syndrome (SVCS); pleural effusion; and various neurologic abnormalities such as vocal cord paralysis, Horner syndrome, paraplegia, diaphragmatic paralysis, and pain in the distribution of specific sensory nerves.

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