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Mediastinal & Chest Wall Tumours

Rare tumours demanding precise surgical expertise and multidisciplinary care

The mediastinum, the central compartment of the chest between the two lungs, and the chest wall, the bony and muscular framework surrounding the thorax, harbour a wide variety of primary tumours, both benign and malignant. Despite their rarity, these tumours often require complex surgical resection and, in many cases, reconstruction to restore chest wall integrity and function.

The Mediastinum: Anatomy and Tumour Distribution

The mediastinum is conventionally divided into anterior, middle, and posterior compartments, each characteristically giving rise to different tumour types. The anterior mediastinum (in front of the heart and trachea) is the most common site for mediastinal tumours: thymoma (discussed separately), lymphoma, germ cell tumours (teratoma, seminoma), and thyroid/parathyroid masses.

The middle mediastinum (containing the heart, trachea, and major vessels) gives rise to pericardial cysts, bronchogenic cysts, and lymph node tumours. The posterior mediastinum is the domain of neurogenic tumours, arising from nerve roots, ganglia, or the sympathetic chain, including schwannoma, neurofibroma, paraganglioma, and malignant peripheral nerve sheath tumours.

Mediastinal Germ Cell Tumours

Germ cell tumours (GCTs) of the mediastinum arise from primordial germ cells that failed to migrate to the gonads during embryogenesis. They most commonly occur in young men in the anterior mediastinum. Mature teratomas, cystic tumours containing hair, teeth, sebum, and other differentiated tissues, are benign and cured by surgical excision. Malignant GCTs (seminomas and non-seminomatous GCTs) are aggressive but highly chemosensitive; surgery plays a crucial role in removing residual masses after chemotherapy.

Mediastinal Cysts

Bronchogenic cysts arise from aberrant budding of the primitive foregut and contain respiratory epithelium. Pericardial cysts are benign outpouchings of the pericardium, most commonly found at the right cardiophrenic angle. Oesophageal duplication cysts, neurenteric cysts, and thoracic duct cysts are other mediastinal cystic lesions. While often asymptomatic, cysts may cause compression, infection, or rupture, and most surgeons recommend excision to confirm the diagnosis and prevent complications.

Neurogenic Tumours of the Posterior Mediastinum

Posterior mediastinal neurogenic tumours are among the most common mediastinal tumours in adults, usually presenting as well-defined paravertebral masses on imaging. Schwannomas and neurofibromas are typically benign and amenable to complete VATS excision. Dumbbell tumours, with intraspinal extension through a neural foramen, require combined neurosurgical and thoracic surgical approach. Malignant peripheral nerve sheath tumours and neuroblastoma/ganglioneuroblastoma in children are aggressive and require multimodal treatment.

Mediastinal Large B-Cell Lymphoma

Primary mediastinal large B-cell lymphoma (PMBCL) is a distinct subtype of aggressive B-cell lymphoma arising from thymic B-cells, typically in young women. It presents as a bulky anterior mediastinal mass with SVC syndrome. Treatment is primarily chemotherapy (R-CHOP or DA-EPOCH-R) with or without radiotherapy. Surgery is mainly diagnostic (biopsy) and occasionally for residual mass assessment.

Chest Wall Tumours

Chest wall tumours arise from the bones (ribs, sternum, clavicle, scapula) or soft tissues of the chest wall. They may be primary (originating in the chest wall) or secondary (metastatic from breast, kidney, thyroid, lung, or other primaries). Common primary bone tumours include chondrosarcoma (the most frequent primary malignant chest wall tumour), Ewing’s sarcoma (in young patients), osteosarcoma, and solitary plasmacytoma. Common soft tissue sarcomas include desmoid tumour, fibrosarcoma, and synovial sarcoma.

Benign chest wall tumours include fibrous dysplasia, osteochondroma, and chondroma (the most common benign chest wall tumour, arising from costal cartilage).

Surgical Treatment and Chest Wall Reconstruction

Wide surgical excision with adequate margins is the cornerstone of treatment for chest wall tumours. Resection typically involves removal of involved ribs, sternum, or clavicle along with overlying soft tissue and skin when affected. The resulting chest wall defect must be reconstructed to restore chest wall rigidity (preventing paradoxical breathing), protect intrathoracic organs, and achieve acceptable cosmetic result.

Reconstruction uses prosthetic materials, polypropylene mesh, titanium rib plates, methylmethacrylate composites, combined with local or free muscle flaps (latissimus dorsi, pectoralis major, rectus abdominis, serratus anterior) and skin grafts or flaps as needed. Complex reconstructions are performed in collaboration with plastic and reconstructive surgeons. For sternal resections, titanium plate sternal reconstruction systems allow stable and durable chest wall repair.

Complex Mediastinal or Chest Wall Tumour?

These rare tumours demand a surgeon experienced in complex resection and reconstruction. Dr. Bhanushali provides specialist assessment and multidisciplinary management.

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+91-9920024001

9920024001

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I had an excellent experience with Dr. Amol Bhanushali for my brother's treatment. His approach to the diagnosis and treatment was very reassuring which every patient and his/her family expect. I am thankful to ...
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I had an excellent experience with Dr. Amol Bhanushali for my brother's treatment. His approach to the diagnosis and treatment was very reassuring which every patient and his/her family expect. I am thankful to him and the entire team at the Hospital.
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One of the oldest and best hospitals of Thane. The staff are polite and helpful. You are informed well in advance if there is any change in the appointment timings. Doctors are good. They have a systematic approach towards the treatment and recommend only those tests and medicines which are required. They make you absolutely comfortable and at ease. Charges are also reasonable. Overall a very satisfying experience.
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My wife, Rekha Tejura, had been suffering from TB for the last couple of years. The infection was in her chest and abdomen both. During the treatment with anti-TB medicines,...
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Hemang Tejura
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My wife, Rekha Tejura, had been suffering from TB for the last couple of years. The infection was in her chest and abdomen both. During the treatment with anti-TB medicines, abdominal infection decreased but chest infection continued to persist. One of her lungs got covered with a very thick layer of pus and that side lung started to fail. At that time, we decided to go for a different doctor and heard about Dr. Amol Bhanushali. We visited him immediately and started treatment. From the very first visit itself, Dr. Bhanushali responded positively and supported us. The surgery was performed successfully using the latest technology available and my wife’s lung was saved. After the operation, she was fit and fine. I am thankful to Dr. Bhanushali for treating my wife.
Hemang Tejura
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My wife, Varsha Garwa, was unwellfor nearly 10 years. She used to a keep coughing a lot and her cough used to contain blood at times. The blood went on increasing...
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Rajesh Garwa
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My wife, Varsha Garwa, was unwellfor nearly 10 years. She used to a keep coughing a lot and her cough used to contain blood at times. The blood went on increasing over the last few years. She had developed a fungal ball (aspergilloma) in a cavity in a part of her lung. She was treated by various doctors, however, nothing worked. By a stroke of luck, we came across Dr. Amol Bhanushali’s name. The treatment offered by Dr. Bhanushali was world class. He was very patient and polite. He explained to us everything about the disease and its treatment. He also instilled confidence in us that the surgery would be successful. The Center for Lung Surgery at Dr. Bhanushali Hospital has state-of-the-art infrastructure and has everything under one roof. My entire family is grateful to Dr. Bhanushali for treating my wife and ending her decade long misery.
Rajesh Garwa
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My mother, Manjushree Patil, had been suffering from MDR-TB and was on anti-TB drugs for six years. She took treatment from different doctors but there was no respite. Through word of...
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Shweta Patil
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My mother, Manjushree Patil, had been suffering from MDR-TB and was on anti-TB drugs for six years. She took treatment from different doctors but there was no respite. Through word of mouth, we came to know about Dr. Amol Bhanushali. During our very first meeting with Dr. Bhanushali, he gave us detailed information about the disease and told us about the treatment. My mother’s left lung was completely destroyed by TB, and the other side was beginning to get affected too, so surgery was needed immediately. We were all very scared but Dr. Bhanushali and his team ensured that the surgery was successful and my mother got rid of TB and recovered completely. We are forever indebted to him for performing the surgery and bringing my mother out of the brink of death, thus giving her a new lease of life.
Shweta Patil