There has been a highly significant increase in the number of patients with malignant mediastinal tumors in the last four decades. Since these lesions are infrequently encountered and there are very few reports in Iran concerning this issue, we performed this study to review our institutional experience of mediastinal masses and to compare differences in the clinical spectrum between our study population and other patients studied by various reports. This was a retrospective, descriptive and cross sectional study conducted on 105 patients with mediastinal masses who underwent surgical resection over a 5-year period from 1999 to 2003 in three major hospitals in Tehran. A total of 105 patients with mediastinal masses including 65 males (62%) and 40 females (38%) with a mean age of 34 years (range,2-80 years) who had undergone surgery entered the study. Most mediastinal tumors (47%) were identified in the third and fifth decades of life and the most common malignancy during the first four decades of life was malignant lymphoma. Considering the location of mediastinal masses,the anterior mediastinum was the most common site (65%) followed by paravertebral sulci (21%) and visceral mediastinum (14%).The highest rate of malignancy was observed in visceral mediastinum (73% malignancy rate). Histopathologic evaluation of resected masses revealed twenty two types of tumors of which sixty percent were malignant. Nonspecific symptoms such as dyspnea (41%) and cough (40%) constituted the most presenting complaints. Twelve percent of patients were completely asymptomatic. The most common complication observed in this series of mediastinal masses was Superior Vena Cava (SVC) syndrome. There was no postoperative complication. Crude mortality rate of the whole series was 16%. The prevalence of tumors in our series varied from some previously published reports. We demonstrated definite differences in histologic distribution, age range, malignancy rate and diagnostic methods of mediastinal tumors between our study population and other reported cases which should be considered in the evaluation and planning of therapeutic modalities for mediastinal masses encountered in our current practice.

Background and objective: The most common tumors of mediastinum are neurogenic tumors, while mediastinal tumors are common in adolescent and middle ages. Lymphoma is a common cause of mediastinal tumors in children. We observed an increase in prevalence of lymphoma in adults. This study was to evaluate mediastinal masses over 5 years duration.Subjects and Methods: The study was carried out over five years stated from 1382 (2003) in three sugery departments of Ahvaz University of Medical Sceinces, Iran. Patients with mediastinal mass were evaluated for age, gender, signs and symptoms, chest X-ray, chest CT scan and the methods of removal and the pathological reports of results of tissue samples.Results: Sixty patients were evaluated and there was no difference in gender. Mediastinal masses were most common in 3rd and 4th decades of life. Anterior mediastinum was the most common involved site. Anterior mediastinotomy was the most common operation from which large tissue samples were taken from 78.33 % and 51.67% of the mediastinal masses were lymphoma.Conclusion: The best method to take large tissue of these tumors is anterior mediastinotomy. The most common pathology in mediastinal masses is lymphoma. Lymphoma must be suspected in young patients with fever, cough, dyspnea and a mediastinal mass.

Background and Objective: Mediastinal masses in children are a heterogenous group of asymptomatic potentially life-threatening congenital, infectious, or neoplastic lesions that present complex diagnostic and therapeutic dilemmas. Materials and Methods: The clinical and laboratory features of 65 patients who had open biopsies in Ali-Asghar hospital over 11 years were reviewed. Results: Seventy-two percent of cases were male and 28% were female. The age varied between 2.5 months and 19 years. Eighty-four percent of lesions were malignant and 16% were benign. Neurogenic tumors were the most common (36.9%). In order of frequency the following lesions were the most common neuroblastoma (mostly in posterior mediastinum), Hodgkin's and non-Hodgkin’s lymphoma (mostly in middle mediastinum), and malignant small round cell tumor (mostly in chest wall). Most patients were presented by fever (21.5%), dyspnea (20%) and cough (12%), especially in Hodgkin’s and non-Hodgkin’s lymphoma. Lymphadenopathy (29.2%) and hepatosplenomegaly (13.8%) were the most frequent clinical signs. Laboratory examination revealed anemia (29%), leukocytosis (35%), and high sedimentation rate (21.5%). Conclusion: The clinical presentation and laboratory findings of mediastinal and chest wall masses are often non-specific and are variable, but according to their clinical data (i.e. age) and location, only few important diagnoses should be considered.

Dear Editor, Patients with mediastinal masses, particularly masses in the anterior or superior mediastinum present unique problems for the anesthesiologists which are during general anesthesia, which are usually the consequence of extrinsic compression of the airway, obstruction of the venous return or obstruction to the output of the heart (1-4).