SPECTRUM OF BENIGN AND MALIGNANT MEDIASTINAL MASSES, DIAGNOSIS, INCIDENCE, AND MANAGEMENT IN THORACIC SURGERY

Abstract

Objectives: The study aims to analyse the clinical spectrum of benign and malignant mediastinal masses, diagnosis, incidence of cases, and their management among patients with thoracic surgery.

Methodology: A prospective study was conducted from November 2022 to January 2024 at the Thoracic Surgery Department in Jinnah Postgraduate Medical Centre, Karachi. All patients aged 12 years and above who were vitally stable were included. All data were collected on a structured questionnaire, and the data were analysed using SPSS version 23.

Result: A total of 93 patients were included, with 58(62.4%) males. The mean age of patients was 40.49 ± 14.0 years. Malignant disease was present in 65(69.9%) patients, with squamous cell carcinoma of the oesophagus being the most common, 30(32.3%), followed by lymphoma, 21(22.6%). Benign masses were seen in 28(30.1%) cases, where thymoma was most frequent 9(10.75%). Radiological assessments, including computed tomography in 91 (97.8%) and MRI in 6(6.6%) patients, were conducted. The visceral compartment was the most common location in 44(47%) patients. The majority of masses were mixed density 91 (97.8%), and mediastinal lymphadenopathy was present in 71(76.3%) of both malignant and benign origin. Loco-regional disease was found in 28(30.1%). Pathological diagnoses were made in 76(81.7%). Treatment included medical management for 72(77.4%), surgery for 55(59%), and palliation for 133(14%).

Conclusion: Mediastinal masses comprise a heterogeneous group of lesions with a predominance of malignant pathology in this study. Squamous cell carcinoma of the oesophagus and lymphoma were the most common malignancies, while thymoma was the leading benign lesion. Multimodal management, combining medical, surgical, and palliative approaches, was essential for optimal outcomes. Early detection and individualized treatment remain key to improving prognosis in mediastinal mass patients.