Mediastinale Tumore

Der Begriff Mediastinaltumor beschreibt eine überaus heterogene Entität von über 90 derartig beschriebenen Läsionen. Die Gemeinsamkeit liegt in der anatomischen Zuordnung und im raumfordernden Charakter.

Abstract

If mediastinal tumours cause symptoms these are related to their anatomical localization or a paraneoplastic syndrome. The differential diagnosis is based on the clinical situation with finding the lesion, and, furthermore, taking into account the age and sex of the patient, and the mediastinal compartment where the lesion is located. Cross-sectional radiographic diagnostic is essential for defining the therapeutic strategy. The anterior mediastinum is dominated by thymic tumours, mediastinal lymphomas, germ cell tumours and ectopic mediastinal poiters. The middle mediastinal compartment is the most frequent place of mediastinal cystic tumours, whereas the posterior mediastinum is the domain of neurogenic tumours. For selected cases a tissue biopsy is required. Surgery is the mainstay for most mediastinal tumours. Median sternotomy is the most frequent conventional surgical technique while minimally invasive surgery with thoracoscopic and above all robot assisted operation techniques are increasingly frequent. Combined chemotherapy and modern radiotherapy are essential components of the comprehensive treatment for mediastinal tumours.

Kernaussagen

• Wenn mediastinale Tumoren Symptome verursachen, stehen diese meist im Zusammenhang mit ihrer Lokalisation oder einer Paraneoplasie.

• Die Differenzialdiagnose beruht auf der klinischen Situation bei Feststellung des Tumors, dem Alter und dem Geschlecht des Patienten/der Patientin und der Zuordnung zum jeweiligen mediastinalen Kompartment.

• Die Schnittbilddiagnostik ist wesentlicher Bestandteil der Therapieplanung.

• Im vorderen Mediastinum dominieren Thymustumoren, mediastinale Lymphome, Keimzelltumoren und mediastinale ektope Schilddrüsen. Im mittleren Mediastinum sind vielfach zystische Raumforderungen vorhanden, während das hintere Mediastinum die Domäne der neurogenen mediastinalen Tumoren darstellt.

• In ausgewählten Fällen ist eine Biopsie zur Therapieplanung erforderlich.

• Die Chirurgie spielt eine wesentliche Rolle in der Behandlung mediastinaler Tumoren.

• Bei den konventionellen Verfahren dominiert die mediane Sternotomie.

• Die minimalinvasive Chirurgie ist mit thorakoskopischen und insbesondere roboterassistierten Operationstechniken zunehmend etabliert.

• Die Kombinationschemotherapie und die moderne Radiotherapie sind essenzielle Bestandteile der komplexen Behandlung mediastinaler Tumoren.

Publication History

Article published online:
02 March 2022

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