Clinical manifestation of pediatric mediastinal tumors, a single center experience

Abstract

Abstract Medical decisions should be well-planned to improve prognosis and reduce complications of mediastinal tumors. In this study, we analyzed the clinical presentations of pediatric mediastinal tumors and their correlation with long-term clinical outcome. Forty patients under 18 years of age diagnosed with mediastinal tumors at China Medical University Children s Hospital between 2001 and 2016 were enrolled. The patients’ sex, age of onset, initial clinical symptoms, and treatment outcomes were analyzed. 75% of the patients with mediastinal tumors in this study were men, and the median age of onset was 13 years old (age range: 0–17 years). The overall mortality rate was 40%. The most common tumors were lymphoma (47.5%), followed by germ cell tumors (12.5%), neuroblastoma (12.5%), and thymoma (7.5%). Neuroblastoma was more prevalent in girls younger than 5 years old. The initial presentations of these patients included breathing difficulty (65%), productive cough (47.5%), pleural effusion (54.5%), superior vena cava (SVC) syndrome (35%), neck mass (35%), airway compression (32.5%), fever (30%), chest pain (27.5%), and pericardial effusion (25%). Lymphomas were more likely to be accompanied by neck mass (52.6% vs19.0%, P\u200a=\u200a.04) and SVC syndrome (52.6% vs 19.0%, P\u200a=\u200a.026), yet also had a better 1-year-survival rate (68.4% vs 52.4%, P\u200a=\u200a.02). Overall, lymphoma should be suspected when children present with neck mass and SVC syndrome. Neuroblastoma with a posterior mediastinal origin should be suspected among children younger than 5 years old. Tumor-related airway obstruction, pleural effusion, and pericardial effusion were leading cause of cardiopulmonary instability during sedation for invasive procedures, which should be managed cautiously.